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4 <br /> UNDERGROL►� TANK PROGRAM OFFICIAL INS ~TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E- HAZELTON AVE- <br /> COUNTY NAME s STOCKTON, CA 95205 COUNTY #� ! <br /> PHONE NO. 468-3423 <br /> SITE NAME: /a INSPECTION DATE: Q <br /> � LOtib i <br /> SITE ADDRESS.- CITY/STATE/ZIP`7 `7 6 44� o? S .,L <br /> CHANGES SITE YES NO TANK TANK Q ;L- TANK �� TANK Q C,4 <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> Q� EXP.DATE' EXP.DATE EXP.(DATE EXP.DATE <br /> OPERATIONAL TANK TANK CaNTEN75 <br /> ,. -a. r <br /> MAJOR MINOR Yep � u�.. w m � 3 � „ � �r <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 � <br /> APPROVED CONSTRUCTION 5 6 �� Y <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 i8 <br /> PIPING 19 20 r � <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 v — <br /> SAFETY HAZARD 35 36 __ -- <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURErx �` <br /> v�. <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPCRS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> �.,','S ,� <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 __ I <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 — <br /> SAMPLWG 53 54 ----- -- <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONF) FOLLOWS: <br /> DO- <br /> FOLLOWS- <br /> 58 <br /> Q d�,, <br /> MAJOR 57 MINOR NO 59 k <br /> VIOL, ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSYRECEIVED BY: <br /> TITLE: RES PHONE: RI=CK: <br /> 5 <br /> HUT-3 ORIGINAL s as C• <br />