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UNDERGROUNIfANK PROGRAM OFFICIAL INSPEION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # 3% <br />PHONE NO. 468-3423 <br />SITE NAME: QtAc6k( <br />d y aGs <br />INSPECTION DATE:zo,/ Z._ckp <br />SITE ADDRESS: <br />co IN 1 /STATE/ZI <br />FLAMMABLE VAPORS REMOVED <br />CHANGES SITE/OWN R/PERMIT? <br />YES NO TANK TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTED COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBERCJ000 NUMBER r(ja(a 0 NUMBER`S f NUMBER <br />PER # , r U { PER # V 14W PER # % PER # <br />43 <br />f <br />44 <br />45 <br />EXP. DATE EXP. DATE <br />EXP. DAT EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />59 <br />PERMIT TO OPERATE <br />1 2 <br />NO <br />❑ <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />VIOL. <br />APPROVED CONSTRUCTION <br />5 6� <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 r 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 _ <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34�� <br />� <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />VZ1, 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />49 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />51 <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 />55 <br />56 <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 <br />59 <br />MAJOR MINOR <br />❑ <br />NO <br />❑ <br />VIOL. VIOL. <br />VIOL. <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: zw d z' <br />OFFICE: INSP: RECEIVED BY <br />TITLE: � PHONE: BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />