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UNDERGROUF TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> 4VSAN JOAQUIN HEALTH DISTRICT,,,,f <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME ¢� STOCKTNO. CA 95205 COUNTY # <br /> C..S U PHONE NO. 468-3423 <br /> SITE NAME: QM S L / INSPECTION DATE: 3 2� <br /> SITE ADDRESS: ODD T CITY/STATE/ZIP s <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER,.,,.,/g , NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER <br /> # PER# lH7Y�yt,�// PER# PER# PER# <br /> T �T7 D EXP.DAT#" 4 ' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONIENIS <br /> MAJOR I MINOR <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 18 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 122 <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 MID7 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <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 REMS REPRESENT IOLATIONS AND MUST BE CORK C ED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLO <br /> 57 58 59 <br /> MAJNO <br /> VIOLOR E:] MOLL ❑ VOL.❑ <br /> OFFICE: I /I� RECEIVED BY: <br /> TItLe� PHONE: RECK: <br /> I <br /> 5/88 0- <br /> HUT-3 <br />