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UNDERGROUNF ANK PROGRAM OFFICIAL INSPE( 'ON REPORT <br /> "AN JOAQUIN HEALTH DISTRICT(----' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # C <br /> V„� J PHONE NO. 468-3423 3 <br /> SITE NAME: INSPECTION DATE: G <br /> pN P/u�,b►•�- , ,�� Pte/ tib' <br /> :ITE ADDRESS: O f N 4 CITY/STATE/ZIP a fru gf 3(0 <br /> RANGES SITE/OWNER/PERMIT? (LEV NO TANK TANK TANK TANK <br /> ORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> fPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> ' 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 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 /> 0IPING 19 20 <br /> NVENTORY 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 /> UNAU HORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> =LAMMABLE VAPORS REMOVED 40 <br /> 4CCESS LOCATIONS SEALED 41 42 <br /> 'OWER DISCONNECTED 43 <br /> .)WNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> 3EMOVAL OF RESIDUAL MATERIALS 46 47 <br /> °IPING 48 49 _ <br /> LAMMABLE VAPORS REMOVED 50 <br /> -INAUTHORIZED RELEASE 51 52 <br /> SAMPLING 153 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> !STEM STATUS(MUST MARK ONE) FOLLO 'p- <br /> MAJOR � MINOR Li NO 5� <br /> VIOL. VIOL. VIOL.ILJ�J <br /> )FFICE: INSP: ' RECEIVED BY: <br /> TITLE: R£ s' PHONE: BECK: <br /> T_l 5/88 <br />