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UNDERGROUICANK PROGRAM OFFICIAL INSP ON REPORT <br />AN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />t7iJ�f>i�l/ /SCP///Yt s PHONE NO. 468-3423 <br />SITE NAME: Pa c �.Z' <br />/ <br />-- INSPECTION DATE: <br />SITE ADDRESS: 1L Np <br />�,-Q <br />`m <br />(� a CITY/STATE/ZIP �/j� �! <br />�- <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK V & <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBE <br />Ia�7g7 <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF IV, SITE COMPUTER # <br />d) T <br />PER # <br />PER # <br />PER # <br />PER # <br />6, _ <br />3 J �� <br />( <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATION L TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28w <br />SAMPLING <br />29 <br />30 <br />µ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSUREOREM <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />— T� <br />7777 <br />ACCESS LOCATIONS SEALED <br />41 <br />42— <br />mm— <br />POWER DISCONNECTED <br />43 <br />T_ <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56THE <br />MARKED ISMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:'�"� r <br />MAJOR 57 MINOR NO 58 <br />❑ <br />a <br />VIOL. VIOL. VIOL. <br />OFFICE: INSPGf^�QJ <br />e <br />�/ l� f� RYlti (�® <br />nP C /l�T e 3-7 & <br />TITLE: SEA i 6R P N �ECK: <br />y UT -3 ORIGINAL ' c 5/58 0M <br />