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UlVWtKUHVUNL` -4NK PROGRAM OFFICIAL INSPE4T --ON REPORT <br /> �AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> s , 1 PHONE NO, 468-3423 COUNTY #& <br /> SITE NAME: <br /> INSPECTION DATE Jp <br /> SITE ADDRESS: I (f-7T CITY/STATE/ZIP �- <br /> CHANGES SITZ=/OWNER/PERMIT? YES NO TANK / TANK TANK TAN <br /> FORM A AND/OR B SUBMITTED? COMPUTER CO UTER COMP ER COMP ER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMB NUMBER NUMBE <br /> dC(J PER# PER # >�' PER# PER# <br /> v EXP.DATE EXP,DATE EXP.DATE EXP-DATE <br /> OPERATIONAL TANK TANK CONTENTS - <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 9 110 <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 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY 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 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <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 REPR ENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIO <br /> OFFICE: INSP: SAM/� � RECEIVED BY: <br /> TITLE: C- S PHONE: BECK: <br /> HUT-3 ORIGINAL alae O, <br />