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UNDERGROUND-TANK PROGRAM OFFICIAL INSPE(=ON REPORT r,� I j <br /> N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: 0 f} W INSPECTION DATE: <br /> SITE ADDRESS: g�3 G✓ / � A15' Rus, LOvp�+ CITY/STATE/ZIP <br /> ZJ7z?eltGa.l <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> 7 -// /� >7 PER# PER# PER# PER# <br /> ,4,//< r EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK C NTENT <br /> MAJOR 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 17 118 1 ��- <br /> PIPING 19 20 ---- --' <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 -1�� — <br /> APPROVED RESPONSE PLAN 25 26UNAUTHORIZED RELEASE RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 — —�– — – —�r_–�— <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL <br /> FLAMMABLE VAPORS REMOVED AO <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 /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> ...... <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST�BE C/Q/RRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> op 42 <br /> OFFICE: 7ITNSLP.- �/ RECEIVED BY: <br /> : PHONE: BECK: <br /> IIT—? (-10Ir-INAI 1 n, <br />