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• UNDERGROUV TILNK PROGRAM OFFICIAL INSPE- `ON REPORT <br /> !N JOAQUIN HEALTH DISTRICT ` 0 <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 466-3423 <br /> COUNTY # 3 9 <br /> SITE NAME: f? �S /_ 6; L Y - INSPECTION DATE: <br /> SITE ADDRESS:(_ 7 <br /> �o kA e7 CITY/STATE/ZIP _ �- <br /> CHANGES SITE/TOWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPU R OMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBEVV NUMBER NUMBER NUMBER <br /> / PER# L;L PER# PER# PER# <br /> EXP.[DATE' 1P EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS - <br /> OPERATIONAL TANK <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 11 112 <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 32 �_— <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 m 43 -- -- <br /> OWNER/OPERATOR MONITORING 44 45 <br /> a <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 `'3 54 W <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 <br /> VIOL MAJOR ❑ VIOIvilliLR ❑ VIOL SILl� <br /> OFFICE: �NSP: RECEIVED BY: <br /> ����f�S PHONE: RECK: <br /> TITLE: <br /> s-ee O <br /> HUT-3 ORIGINAL <br />