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� . fi <br /> UNDERGROUTANK PROGRAM OFFICIAL INSPTION REPORT 1 <br /> AN JOAQUIN HEALTH DISTRICT W <br /> 1601 E. HAZELTON AVE. m •;; <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY #-3? . <br /> ®� PHONE NO. 468-3423 <br /> SITE NAME: P # �� �.'' ��{ INSPECTION DATE: ��Z �� Gr'0 <br /> SITE ADDRESS: 333 0 / d /qr RG�� CITY/STATE/ZIP og, <br /> CHANGES SITE 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 /> /4t?o EXP.DATE EXP:DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS. <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 °4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 110 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 <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 /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M43 <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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 M <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VI LATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 'Le <br /> 59 <br /> MAJOR 57 MINOR Ei NO <br /> VIOL. VIOL. VIOL. <br /> C!.4-1 ` 'd'' <br /> OFFICE: INSP: <br /> o �?D, etpf <br /> TITLE: 17 PHONE: /L K- <br /> YT <br /> siss ©M <br /> HUT-3 ORIGINAL— <br />