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UNDERGROOf 4NK PROGRAM OFFICIAL INZ*lr 'ON REPORT <br /> ` ,AN JOAQUIN HEALTH DISTRI *ftwo' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> �ea mor, Oi% (f-v , <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> 3YYc E - rrr g "H <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# l f7 3z01 PER# f/T3-Q,�- PER# //;73,( PER# <br /> �j <br /> 11 -7-J-3 EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> iA <br /> '' <br /> TANK CONTENTS •' `z s <br /> OPERATIONAL TANK X <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 <br /> APPROVED MONITORING SYSTEM 9 _1'0 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 0 <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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSUREN <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT-TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 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 /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR NO 58 59 <br /> VIOL. VIOL ❑ VIOL❑ <br /> f <br /> OFFICE: INSP: C? RECEIVED BY: s <br /> - <br /> TITLE: PHONE: . BECK: f. 1 <br /> sees O, <br /> HUT-3 ORIGINAL <br />