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' UNDERGROUNDr' —4NK PROGRAM OFFICIAL INSPF;r'""7N REPORT <br /> 4 JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO, 468-3423 <br /> SITE NAME: Q� s(d�����' � / ^o J INSPECTION DATE � �� ! <br /> SITE ADDRESS: b� fJd 2I CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT'? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER 7--- COMPUTER 3 COMPU ER <br /> TYPE OF INSPECTI( � SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> VV"5 PER* PER i` PER# PER aft I <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE I <br /> OPERATIONAL TANK rnnrx coNreHrs <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 g <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 19 120 <br /> INVENTORY RECONCIUATION 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 36 u _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 l <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 46 147 <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 ITE REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: r {� 5 T S <br /> IeZA <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. LiVIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: �s PHONE: JBECK: <br /> HUT--3 ✓ORIGINAL siaa O N <br />