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UNDERGROUP"` TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> 116410�Ahl JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 _ COUNTY # <br /> i PHONE NO. 468-3423 <br /> SITE NAME: f INSPECTION DATE: iV71?Q <br /> I M � � ►iC7! C'(JGt <br /> SITE ADDRESS: Q' a CITY/STATE/ZIP Cr_ <br />` CHANGES SITE/OWNER/PERMIT. YES NO TANK I- TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUT COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> _r /� PER# 10',"(N•0• PER# PER # PER# <br /> N 1't 187150 EXP.DATE JJ EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS _e °e,,.. �. e'.. ®.a"^Ss 4S°.ta'° a'a r�,+.�,„;'�s;�, ...<':s y°. -.sv -aa4�� t ✓P - ✓-'° 4... <br /> OPERATIONAL TANK . k, ¢ � d� e # <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 � mm <br /> WRITTEN MONITORING PROCEDURES 7 <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 /> f PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 mm <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 372 go <br /> TEMPORARY TANK CLOSURE � .. �T '.. <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 ___ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43mm � � <br /> OWNER/OPERATOR MONITORING 44 4551 <br /> PERMANENT TANK CLOSURE � �. lwi"'� <br /> A ,�� <br /> ✓�' h so f 4 95 Sl <' y�^3y i'y Ab0ti 4° ✓.'.. <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 � __ <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 - � <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECT AS <br /> SYSTEM STATUS(MUST MARK pNE1 FOLLOWS:— V64 ,,.5 gC l(a , 1Jf"1M! <br /> MAJOR 57 MINOR 58 NO 59 �a <br /> VIOL. ❑ VIOL ❑ VIOL. � <br /> OFFICE: INSP: owl� RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> NUT-3 OWNER'S COPY. eiea POM <br />