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UNDERGROUND FK PROGRAM OFFICIAL INSPEC N REPORT <br />JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br />PHONE NO. 468-3423 <br />SITE NAME: , j <br />�� -L"AT <br />:t3 `�' <br />INSPECTION DATE: <br />SITE ADDRESS: ' ; <br />LL_ <br />CITY/STATE/ZIP_ <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK r <br />TANK <br />TANK -3 TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />NUMBER ffOOU NUMBER Jo Q4 <br />OMPUTER COMPUTER <br />NUMBE7000 j7 NUMBER <br />TYPE OF INSPECTION SITE COMPUTER <br /># <br />PER # v <br />PER # v Z-.: <br />PER # !( PER # <br />NG <br />/� <br />EXP. DAT <br />EXP. DATE <br />EXP. DAT XP. DATE <br />OPERATIONAL 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 />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />_... _ .._ <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />�.___������ <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43�_ <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 />155 <br />156 <br />THE MARKED ITEMSREPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOW . <br />�.z*le— ��T 9C\/ Ge <br />K A -I ~;l iV bE <br />57 58 <br />_ <br />dc <br />MAJOR MINOR NO <br />❑ ElVIOL. <br />�59Aku-1 <br />_ <br />VIOL. VIOL. <br />L,LNJ <br />Rhe <br />OFFICE: <br />INSP/RE <br />EIVED BY: <br />t+ <br />TITLE: %7 `5 i�i� <br />PHO � , �Z j% <br />RECK: <br />HUT -3 `ORIGINAL 5/88 0" <br />