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L <br /> UNDERGROUN NK PROGRAM OFFICIAL INSPE ON REPORT <br /> %VAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE N . 468-3423 <br /> SITE NAME: A/ �'�9/� INSPECTION DATE: <br /> i SITE ADDRESS: �(J 5-� � lC•�, CITY/STATE/ZIP 5'jXA//e!;4 7s zoo <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK �, TANK /TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> O EXP.DATE EXP:DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT OPERATE 1 2 <br /> IN <br /> CHANGE IN CONDITIONS TO OPERATE 3 43 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> 7�� <br /> APPROVED MONITOR FREQUENCY 13 14 _ <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REVOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 _.a m <br /> ACCESS LOCATIONS SEALED 41 42 � � �� � �-- -"`.............__....,.......___.. <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 y► .��0 W4 <br /> UNAUTHORIZED RELEASE 51 52 �} OL— <br /> .&-SAMPLING 53 54 <br /> _ .._ . <br /> IMPROPER ABANDONMENT 55 56 ' <br /> THE MARKED ITEMS REPRESENT VIOLATION ANDMUSTBE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: S 0 /� s�1f-7-16 o <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: REC <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 O" <br />