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UNDERGROUN*NK PROGRAM OFFICIAL INSPE(jpN REPORT <br />N JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br />PHONE NO. 468-3423 <br />SITE NAME: Q INSPECTION DATE: <br />SITE ADDRESS:,/ ZI",160�N CITY/STATE/ZIP' 4C, (i,& g.S�-76 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 'Z-, TAN,,JJK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE} COMPUTER <br />NUMBERf,,40 0 NUMBE NUMBERIU O� NUMBER <br />TYOF INSP CTION SITE COMPUTER # ,,, �� <br />/L.- (�G( <br />PER # 1P° (% PER # G/ PER # PER # <br />/ EXP. DATE EXP. DATE v EXP. DA E EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR " <br />PERMIT TO OPERATE 1 2 <br />m <br />CHANGE IN CONDITIONS TO OPERATE 3 4 <br />APPROVED CONSTRUCTION 5 6 <br />WRITTEN MONITORING PROCEDURES 7 8 <br />APPROVED MONITORING SYSTEM 9 10 <br />MONITORING SYSTEM 11 12 <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 29 130 <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 />REMOVAL OF RESIDUAL 38 39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED 43 <br />• <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 a __._.... <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 155 56 <br />THE MARKED ITEMS REPRESENT IOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />��g� <br />MAJOR Ej MINOR LJ INP - <br />VIOL. <br />VIOL. VIOL. VIO . <br />OFFICE: INSP: RECEIVE Y: <br />TITLE: � S PHOi?-. RECK: <br />HUT -3 ORIGINAL 5/88 ©"" <br />