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AN JOAQUIN HEALTH DRSTPICT <br /> 1601 E. HAZELTON AVE. <br /> � j� STOCKTON, CA 95205 � �1� f <br /> PHONE NO 468-3423 <br /> ;ITE NAME: �� XGy� _. INSPECTION DATE J'Z.—ff <br /> SITE ADDRESS: { �' CITY/STATE/ZIP 1S� �. <br /> CHANGES SITE/OWNED/PERMIT? YES NO TANK . TANK TANK . �- TANK '-f <br /> FORM A AND/OR B SUBMITTED? COMPUTER_ COMPUTER COMPUTER COMPUTER <br /> NUMBER l�� NUMBER ! NUMBER Ute NUMBER <br /> TYPE OF INSPECTION / SITE COMPUTER# � � ,N ��� <br /> r OIfG�C �j PER 5i ' PER # /f /PER 415-✓ PER aFQ <br /> / / EXP.DATE[/ EXP.DATE EXP.DAT EXP.DATE <br /> TANK CONThOPERATIONAL TANK .,- , `".e"�✓ t J A � n "F <br /> R . <br /> MAJOR M110R <br /> �F- <br /> �e� <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 �— <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 78 - <br /> PIPING 19 120 1 -- <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 124 <br /> APPROVED RESPONSE PLAN 125 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 _ �........_- ...._.. -- -_____r__ _ .�� _._................M._ <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 - <br /> SAFETY HAZARD 35 - 36 <br /> CONDITIONS ABATED VZX, <br /> .3 <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 <br /> PERMIANI=NT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE W%FORS REMOVED 50 - <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53154 <br /> IMPROPER:ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPP,ESENT VIOLATIONS AND iAUST BE CORRECTED A5 / <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOn /.' � -y l <br /> 57 58 <br /> I'JIAJOR MINOR �t �� NO <br /> VIOL VIDL. I VIOL, <br /> - T1s <br /> - f F�^'i�t;S �+� i+✓ff?��i�f��!_�',yJ�—��+ � brf� p� J'"iy�,�l',t�-/L�r'—,Lf <br /> f`s.���:: F—Ui/ ".c..�=����iC.3 '�VC�"i (..p"J f�'9 /t'7 s.. ✓'"} _ f�f ��.�,Q+'�� <br /> OFFICE: RCEIVI I `3Y: <br /> TITi_E: <br /> I`iJ�-5 ✓'.r53(�=�I.i`,iY.L 5'�8 '✓M <br />