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UNDERGROUNCt 4NK PROGRAM OFFICIAL INSPE( N REPORT <br /> AN JOAQUIN HEALTH DISTRICT- <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 CUl1NTY # <br /> SITE NAME: Prr INSPECTION DATE: jJ3 <br /> SITE ADDRESS: �!S(' ri''� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? " N TANK p ! TANK 0Z TANK TANK <br /> r FORM A AND/OR B SUBMITTED? COMPUTER .; COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> L PER# PER# PER# PER# <br />' df/Q� ! EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> :i <br />" MAJOR MINOR <br /> PERMIT TO OPERATE 1 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE. 3 4 <br /> r APPROVED CONSTRUCTION5 6 � <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> I APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY X13 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 p <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 ', 36 <br /> CONDITIONS ABATED X37 <br /> I .9 a:•''a;,e.pr,.;.CLOSURE <br /> ,.� a... <br /> TEMPORARY TANK <br /> ve 4' 4a mi >� Y � a✓s 9` sf. a °"Sa , 4w a 1,101. , y.,•, <br /> �°...�= <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 45 __ <br /> i <br /> ' eam <br /> PERMANENT TANK:CLOSURE �° s� <br /> � i° � $ a� ^ <br /> I REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPINGL i 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE II 51 r54 <br /> SAMPLING i 53 IMPROPER ABANDONMENT 55 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) .��{��re��5 '0(E�PAOLLOWS: <br /> c:4j GIC S r /4 Pdsrvc4r�> v i <br /> /57 58 59 <br /> MAJORMINOR NO a �a . I r S f)Cl, <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ r , /nrr� s>�a. ;�.' of ter.�� C/�>7f r ��. /�ts1 a•<f <br /> c <br /> OFFICE: INSP: RECEIVED BY: <br /> ;I <br /> ti TITLEA�C-; PHONE: BECK: I <br /> FILE COPYSias OM <br />