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UNDERGROUANK PROGRAM OFFICIAL INSP ON REPORT <br /> CAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. - - <br /> COUNTY NAMECOUNTY # <br /> STOCKTON; CA 95205 <br /> '•PHONE NO.-468-3423 - <br />'I SITE NAME: .. L INSPECTION DATE: y _g <br /> SITE ADDRESS: s CITY/STATE/ZIP / <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# 1503"0/ PER# 1S03'O PER# /SUj-oj PER# <br /> TQry,� /�PSZQv[t!+ �Sd3 EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK T KCON NTS ' <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 8 - <br /> APPROVED MONITORING SYSTEM '.I : 9 10 <br /> MONITORING SYSTEM - - 11 12 ' <br /> r <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> -ACCESS CASING SECURED - 17 18 <br /> PIPING -- 19 20 - - - - - <br /> I�� 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,T' 33 34 - - <br /> SAFETY HAZARD". :;.. ::.: .:-35 136 1 <br /> CONDITIONS ABATED 37 - - <br /> TEMPORARY TANK CLOSURE ' <br /> REMOVAL OF RESIDUAL 36 39 • - f <br /> FLAMMABLE VAPORS REMOVED 40 -• - -sLL`• <br /> ACCESS LOCATIONS SEALED " 41 42 <br /> POWER DISCONNECTED -,: - 43 <br /> OWNER/OPERATOR MONITORING . .:;�` 44 45 - <br /> RMANENT TANK CLOSUREPr <br /> d <br /> REMOVAL 46 47 r' <br /> 48 49 - - - <br /> FLAMMABLE VAPORS REMOVED 50 <br /> .UNAUTHORIZED RELEASE 51 52 - - <br /> SAMPLING5354 <br /> - <br /> IMPROPEWABANDONMENT 55 56. THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS ` <br /> SYSTEM STATUS(MUST MARK ONE) - - - 3> yC700 <br /> .. � . :. . FOLLOWS: <br /> MAJOR 57 MINOR 58 NO S9 a!!7f <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE INSP: RECEIVED BY <br /> TITLE:/P•��If i Si PHONE: RECK a a <br /> -�?3mp.� <br /> .z�;.r,F'k»;d e'r: . . ORIGINAL <br />