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UNDERGROUNTANK PROGRAM OFFICIAL INSP ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME, c%a u/N ('putt-{ STOCKTON, CA 95205 COUNTY # -37 <br />PHONE NO. 468-3423 <br />SITE NAME: g6a 67A—mot 5 / INSPECTION DATE: fes/ <br />32 <br />SITE ADDRESS:LeaA CITY/STATE/ZIP �f _k 520- <br />CHANGES SITE/OWN R/PERMIT? IES NO <br />TANK ,qTANK <br />OT TANK <br />TANK <br />SAFETY HAZARD 35 <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER (/ Y <br />COMPUTER COMPUTER <br />COMPUTER <br />37 <br />NU ---NUMBER <br />�, "'w <br />PER # / 2P 9 <br />EXP. DATE <br />NUMBER <br />PER # PER # <br />EXP. DATE EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE OF INSPECTION <br />i <br />G l <br />SITE COMPUTER # <br />�/� <br />REMOVAL OF RESIDUAL 38 <br />OPERATIONAL TANK <br />TANK CONTENTS <br />FLAMMABLE VAPORS REMOVED 40 <br />MAJOR MINOR <br />42 <br />1 2 <br />43 <br />PERMIT TO OPERATE <br />OWNER/OPERATOR MONITORING 44 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />_ <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />APPROVED CONSTRUCTION <br />5 6 <br />PIPING 48 <br />49 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />UNAUTHORIZED RELEASE 51 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />SAMPLING 53 <br />54 <br />MONITORING SYSTEM <br />11 12 <br />56 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />SYSTEM STATUS (MUST MARK ONE)//"p <br />FOLLOWS: Q <br />%��"k/ S ®y aqc/ d 0l%t� 7jwd f <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />Sq <br />&Ael- IV"57 <br />58 59 <br />MAJO VIOL. VIOL. R ❑ VOL. 11 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />a <br />OFFICE: <br />1 <br />HUT -3 <br />INSP: RECEIVED BY: <br />TITLE: PHONE: <br />ORIGINAL <br />BECK: <br />5/88 © m <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />,W <br />SAFETY HAZARD 35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE. <br />. <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING 44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52 <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AE <br />SYSTEM STATUS (MUST MARK ONE)//"p <br />FOLLOWS: Q <br />%��"k/ S ®y aqc/ d 0l%t� 7jwd f <br />Ciul"I �do j2P.ywolA-y/r <br />Sq <br />&Ael- IV"57 <br />58 59 <br />MAJO VIOL. VIOL. R ❑ VOL. 11 <br />-vow '--A!,--� �n�o � o <br />OFFICE: <br />1 <br />HUT -3 <br />INSP: RECEIVED BY: <br />TITLE: PHONE: <br />ORIGINAL <br />BECK: <br />5/88 © m <br />