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UNDERGROUIr;TANK PROGRAM OFFICIAL INSP �' T`ION REPORT " <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E..HAZELTON AVE. <br /> - srocKTON, cA ss205COUNTY NAMECOUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: ? INSPECTION DATE: <br /> SITE ADDRESS: sj /`O . =. 4 CITY/STATE/ZIPS-�o� ,,, 9a� <br />- CHANGES SITE/OWNER/PERMIT? YES CINO (TANK 01 ' TANK Qom, TANK' 03 . -.= TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER. COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER'_ - <br /> J PER#•. PER# PER# PER#. <br /> r r-04lrk-. / I EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS " <br /> MAJOP MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONETORING-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 V 18 <br /> PIPING' _` , 19. 20 <br /> INVENTORY RECONCILIATION'_ 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25m . 26 <br /> UNAUTHORIZED RELEASE.OCCURRENCE. 27.• 2$ <br /> SAMPLING 29 , 30 <br /> APPROVED mTANK REPAIRS 31 - 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 135 m 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE ' <br />= REMOVAL OF RESIDUAL - 38m 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED_ 41 . 42 <br /> POWER DISCONNECTED :. <br /> OWNER/OPERATOR MONITORING 44. •. 45 <br /> PERMANENT TANK CLOSURE _ x <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING o c ` 48 49tJ <br /> FLAMMABLE VAPORS REMOVED 50 <br /> _ UNAUTHORIZED RELEASE -, 51 52 <br /> �1--; _ 53- 54 <br /> SAMPLING:=N•.,: a _ _ <br /> IMPROPER ABANDONMENT_ . 77— <br /> _ <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECT_ED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: - <br /> MAJOR 57 58 <br /> MINOR NO .x 59 <br /> VIOL - VIOL '❑ VIOL 0 <br /> . lNSP_: <br /> OFFICE: <br /> ti :a7A mS , <br /> TITLE _ OITE <br /> (}i��7 PH :. <br />' . <br /> HUS 3 'ORIGINAL. /�1^ .. siee 0M <br />