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UNDERGROUNNK <br />PROGRAM OFFICIAL INSPEjfON <br />taAN <br />REPORT <br />JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY #� <br />SITE NAME:/',meq <6o <br />-57-7717-/ D N "J <br />INSPECTION DATE: <br />SITE ADDRESS: . CITY/STATE/ZIP <br />CA 15-37� <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK <br />TANK <br />TANK <br />=ORM A AND/OR B SUBMITTED? <br />COMPUTE COMPUTER <br />COMPOR <br />COMPUTER <br />NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # PER # PER # <br />/7C Z640 1 / EXP. DATE EXP. DATE <br />NUMBE <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />3 4 <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />15 16 <br />MONITORING RECORDS MAINTAINED <br />17 18 <br />ACCESS CASING SECURED <br />PIPING <br />19 20 <br />21 22 <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />/ 37 <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 />MAJOR 57 MINOR '' 58 59 <br />NO <br />VIOL ❑ VIOL. .L>I VIOL ❑ <br />OFFICE: I INSP: <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BEE CORRCTED AS <br />Gni i n�nre• �1D i�,� Ali �% /' L/ <br />TITLE: t< LC <br />HUT -3 ORIGINAL <br />RECEIVED BY: <br />X6(all <br />PHONE: <br />RECK: <br />5/88 © n <br />mm <br />®m <br />MAJOR 57 MINOR '' 58 59 <br />NO <br />VIOL ❑ VIOL. .L>I VIOL ❑ <br />OFFICE: I INSP: <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BEE CORRCTED AS <br />Gni i n�nre• �1D i�,� Ali �% /' L/ <br />TITLE: t< LC <br />HUT -3 ORIGINAL <br />RECEIVED BY: <br />X6(all <br />PHONE: <br />RECK: <br />5/88 © n <br />