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UNDERGROUNQWNK PROGRAM OFFICIAL INSPE RON REPORT F „� <br /> •MRN JOAQUIN HEALTH DISTRICI n <br /> P <br /> 1601 E. HAZELTON AVE. <br /> COUNT/ NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: VW es' SGRtli� INSPECTION DATE: <br /> SITE ADDRESS: /6 60 141 D�,p�jf}Iy CITY/STATE/ZIP j eI — 9x3701 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER !fS NUMBER 3(O NUMBER NUMBER <br /> / �/ Q���� ���J1 PER# (j1 0)L PER# PER# PER# <br /> /// )e 404 oo �/ - EXP.DATE" EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 12 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 -. <br /> WRITTEN MONITORING PROCEDURES 7 8 - <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 20 <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 /> APPROVED TANK REPAIRS 31 32 <br /> ��`--`UTHORIZED RELEASES REPORTED 33 �34 <br /> ETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 142 _ <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 145 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS46 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 CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR <br /> 57 MINOR 58 59 <br /> NO <br /> VIOL. ❑ VIOL ❑ VIOL <br /> O FICE: INSP: (�/ RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL siae OM <br />