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UNDERGRO�NK PROGRAM OFFICIAL INSON REPORT <br /> N JOAQUIN HEALTH DISTRIC <br /> 1601 E HAZELTON AVE <br /> 6UNrY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO 468-3423 3 <br /> 4VMEAINSPECTION DATE <br /> DDRESS CITY/STATE/ZIP- <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER �U UMBER,06 a ,o NUMBER `a6�j NUMBER /p pp y <br /> PER# PER# PER # PER# <br /> EXP DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK COITTENTS �. <br /> MAJOR MINOR z <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE. 3 4 <br /> APPROVED CONSTRUCTION 5 6 _ <br /> WRITTEN MONITORING PROCEDURES 7 8 f _ <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 - <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING,SECURED 17 18 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> I.APPROVED TANK REPAIRS 31 32 — _ <br /> NAUTHORIZED RELEASES REPORTED 33 34 <br /> AFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 — <br /> - p D <br /> t <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 __ - <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 — <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> emRlNnl��' 48 49 <br /> BLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 — <br /> IMPROPER ABANDONMENT 55 56THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS <br /> MAJOR 57 58 59 <br /> MINOR <br /> VIOL VIOL ❑ VIOL 0 ' <br /> OFFICE INSP RECEIVED BY , <br /> llL��-31/6� <br /> TITLE ` PHONE RECK <br /> HUT-3 OWNER'S COPY s�sa OM <br />