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UNDERGROUND NK PROGRAM OFFICIAL INSPE 'TION REPORT ( 4("21 <br /> G� AN JOAQUIN HEALTH DISTRICT '�—.� <br /> f <br /> 1601 E. HAZELTON AVE. <br /> BOUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: Ckew ge)1 U56 INSPECTION DATE: S <br /> SITE ADDRESS: �`� �t ` / 6, CITY/STAT / P <br /> CHANGES SITE/OWNER//PERMIT? YES NO TANK j-Sptl �O TANK S- TANK j- TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEFj ,y„� LITECOMPF �C COMPUTE COMPUTER <br /> NUMBER �i�1•/K!���,. NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER # PER# <br /> D EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANG coN ENn <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 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 131 132 _ _.— <br /> UNAUTHORIZED RELEASES REPORTED 133 134 <br /> SAFETY HAZARD 35 136CONDITIONS ABATED <br /> ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> - <br /> - <br /> FLAMMABLEVAPORSREMOVED ___ _ __ -- -- ------ <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED 50 _ __ <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> C <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> L <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ C VIOL. ❑ VIOL. <br /> UV <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: �f PHONE: BECK: <br /> siea O <br /> HUT-3 ORIGINAL <br />