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UNDERGROUV-�TANK PROGRAM OFFICIAL INSPp_'%,TION REPORT <br /> 3AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME /y{ � STOCKTON, CA 95205 COMITY # I <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 7 p7D (0 <br /> h C ^ 1 <br /> SITE ADDRESS: 150 <br /> CITY/STATE/ZIP <br /> I <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK j TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBERS NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> CC� -�Z EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 F <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 F i <br /> APPROVED CONSTRUCTION 5 6 I <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 ° 1 <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 E <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> r <br /> TANK GAUGING 23 24 <br /> r APPROVED RESPONSE PLAN 25 26 !b I <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 I <br /> APPROVED TANK REPAIRS 31 32 I <br /> I <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <br /> i <br /> z <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> r. <br /> POWER DISCONNECTED MM <br /> 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> I <br /> PERMANENT TANK CLOSURE �I W <br /> 5 � <br /> 0 ' v M-1 <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 f <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br />+ IMPROPER ABANDONMENT 155 156 <br /> II THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> I. SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> I MAJOR L u MINOR ❑ VI ❑ <br /> VIOL. VIOL. VIOL. + j <br /> 4 <br /> OFFICE: INSP: �� RECEIVED BY: <br /> r <br /> 4 <br /> TITLE: �� s PHONE: f BECK: <br /> HUT--3 Y ,ORIGINAL <br /> 'I <br />