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UNDERGROUND NK PROGRAM OFFICIAL INSPEC N REPORT o Z <br /> JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: 4 v INSPECTION DATE: <br /> 664 � � / <br /> SITE ADDRESS: S- LC LvL� S.�CITY/STATE/ZIP S ,V <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTED W COMPUTE O <br /> NUMBE 1D 0 NUMBER 11V' NUMBER nr-5P� NUMBER <br /> TYPE OFF INSPECTION SITE COMPUTER# PER# V to 6'0 PER# l izoV PER# I'LOO 0 PER# S 5t7 <br /> EXP DATE EXP.DATE EXP.DATE EXP.DATEr <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 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 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 43 w <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING48 49 - ,.... ._�..�.,,...,__._._......._.._�.,_ ,w..,_.._. <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 ,. ... + <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED TEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED <br /> �AS� � <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: & �k C�,�� <br /> z <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL. Lont VIOL. ❑ VIOL.❑ AA <br /> 4 Y1 <br /> OFFICE: INSP• RECEIVED y R <br /> TITLE: PHONE: IRECK:, <br /> HUT-3 ORIGINAL 5/88 0"" <br />