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UNDERGROUN.VIZ&NK PROGRAM OFFICIAL INSPE N REPORT <br /> WN JOAQUIN HEALTH DISTRICT ( off 3 <br /> 1601 E. HAZELTON AVE. - <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: D4 M <br /> (cte INSPECTION DATE: <br /> SITE ADDRESS: t" S- 1 CITY/STATE/ZIP&�� <br /> CHANGES SITE/OWN tER_(/PERMIT? YES NO TANK + TANK ?/ TANK TANK 1,� <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE} COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMB ��Q NUMBE�t%� NUMBERli1 NUMBER60 l7 <br /> PER# (�`, PER#/ Q PER# / PER# <br /> 77-�2- 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 10 ri <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 RECONCILIATION21 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 CLOSUREin <br /> REMOVAL OF RESIDUAL 38 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 424VT� `""`. .....�,�� _ ..__..... ._...__.._....._.�_,- <br /> POWER DISCONNECTED 43 <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 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL`. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: i7D BY: <br /> r <br /> TITLE: �Z/l PHONE: BECK: <br /> HUT-3 ORIGINAL 5/88 0' <br />