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UNDERGROUIR TANK PROGRAM OFFICIAL INSPECTION REPORT <br />SAN JOAQUIN HEALTH DISTRICI0 <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: 1( k <br />INSPECTION DATE: _ i <br />SITE ADDRESS: SOS <br />A/ <br />��,� �t.� <br />CITY/STATE/ZIP <br />aoA-rs <br />CHANGES SITE YES NO <br />FORM A AND/OR B SUBMITTED? <br />PE F INSPECTION SITE COMPUTER # <br />I22 I? L l V / 1 z- <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE ` <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK 3 TANK <br />COMPUTER COMPUTER . <br />NUMBER NUMBER <br />PER # PER # <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK coNTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />y <br />X� <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />9C. <br />PIPING <br />19)r,20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25-Y, 26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br />SAMPLING <br />29 30 <br />d <br />APPROVED TANK REPAIRS 31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />o 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 />38 39 <br />40 <br />41 42 <br />44 45 <br />I MAJOR57 �A�VioL <br />INOHNVI% HVIOL.. OL. <br />THE MARKED ITEMS REPRESENT VIOLATIONS A'N�jD MUST BE CORRECTED AS <br />OFFICE: INSP�:,/_,� / RECEIVED BY: <br />e�� /�./,- <br />TITLE:/?:�- `)S PHONE: BECK: <br />NUT -3 ORIGINAL 5/88 0 <br />