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UNDERGROUF "ANK PROGRAM OFFICIAL 1NSPI"u- -ON REPORT <br /> IN JOAQUIN HEALTH DISTRICT <br /> 1501 E. HAZELTON AVE. <br /> I COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> fSITE NAME: �C INSPECTION DATE: <br /> Aj <br /> u , fir _0b � C� �12 <br /> E SITE ADDRESS: 7 z <br /> �S �� CITY/STATE/ZIPS <br />'. <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER OMPUTER COMPUTER COMPUTER <br /> NUMBE70 QU NUMBER NUMBER NUMBER <br /> E TYPE OF INSPECTION SITE COMPUTE # PER#v�, PER# PER# PER# <br /> ' 6 EXP.DATEt 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 32 <br /> 5' <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 - <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE MIA <br /> ?_ E <br /> REMOVAL OF RESIDUAL 38 139 _ _- <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE W- 4=0 R_`� " <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 _ <br /> PIPING 48 149 <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 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: f PHONE: BECK: <br /> Sim N. <br /> HUT-3 ORIGINAL <br />