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r UNDERGROUNDK <br />PROGRAM OFFICIAL INSPECT <br />REPORT <br />PER # •# .37d <br />PER # <br />JOAOUIN HEALTH DISTRICT <br />EXP. DATE - iXk S } • <br />P9 c; ?I <br />EXP. DATE -,Pei I) - <br />1601 E. HAZELTON AVE. <br />TANK CONTENTS <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY # <br />MAJOR MINOR <br />PHONE NO. 468-3423 <br />1 2 <br />SITE NAME: <br />INSPECTION DATE: 7 <br />SITE ADDRESS: <br />n CITY/STATE/ZIP <br />5 6 <br />1� <br />c. ✓p <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO TANK 2 L/ TANK ®25 <br />TANK a G <br />TANK 2-7. <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER Cs) COMPUTER (4) <br />COMPUTER (i) <br />COMPUTER (� <br />11 12 <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION ISITE COMPUTER # <br />--4-3 7 5 <br />-4 3 7 7 <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />IMM <br />WIIIIIIIII19 <br />=m <br />=0 <br />®® <br />®m <br />®m <br />59 <br />MAJOR �j MINOR Lj NO <br />VIOL. Ll VIOL. VIOL. <br />OFFICE: <br />TITLE: <br />I HUT -3 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />ORIGINAL <br />RECEIVE'(? ¢YF ;jo _ <br />V4.. <br />PHONE: BECK: <br />5/88 0 M <br />PER # '4-77LI <br />PER # <br />PER # •# .37d <br />PER # <br />EXP. DATE - iXk S } • <br />EXP. DATE f�c( S <br />EXP. DATE -,Pei I) - <br />EXP. DATE jW SF. <br />TANK CONTENTS <br />ol <br />Nis= <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />11 12 <br />13 14 <br />.� <br />15 16 <br />17 18 <br />19 20 <br />X <br />_� <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />IMM <br />WIIIIIIIII19 <br />=m <br />=0 <br />®® <br />®m <br />®m <br />59 <br />MAJOR �j MINOR Lj NO <br />VIOL. Ll VIOL. VIOL. <br />OFFICE: <br />TITLE: <br />I HUT -3 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />ORIGINAL <br />RECEIVE'(? ¢YF ;jo _ <br />V4.. <br />PHONE: BECK: <br />5/88 0 M <br />