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.lOAQUIN HEAL 'DIS IC <br />1601 E. HAZELTON AVE. <br />Y ���E <br />STOCKTON,`CA 95205 <br />COUNTY # <br />r,r.,, <br />PHONE NO. 468-3423 <br />SITE NAME: ` <br />` } <br />INSPECTION DATE: i iJ t <br />SITE ADDRESS: <br />J ITY/STATE/ZI <br />coul` <br />t <br />Cs (Ct <br />CHANGE SITE/ WNER/PERMIT? <br />ES <br />NO <br />TANK ( <br />TANK C) <br />TANK' O TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER - I I C <br />COMPUTER <br />NUMBER ; (� 0 C� <br />COMPUTER COMPUTER <br />NUMBER C1 NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />PER # <br />PER # <br />PER # PER # <br />{f lA o <br />iL <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE :EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4� <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />! <br />APPROVED MONITORING` SYSTEM <br />9 <br />110 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />122 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />_ <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />... _ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />134 <br />SAFETY HAZARD <br />35 <br />136 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE " <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: ` d -" > x it ov-e -t <br />afe } <br />C <br />a` <br />y ,L T <br />57 58 <br />59 <br />d & b <br />C.k� i <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL <br />L <br />e 4 <br />OFFICE: <br />INSP: <br />o <br />RECEIVED BY: <br />TITLE:PHONE: <br />o I <br />RECK: <br />