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UNDERGROU ANK PROGRAM OFFICIAL INSP TION REPORT <br /> N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME /- STOCKTON, CA 95205 COUNTY # <br /> Gf(0 CIN PHONE NO. 468-3423 3� <br /> SITE NAME: INSPECTION DATE: <br /> 5 o N's NercF� 4wJ Air /91 <br /> SITE ADDRESS- CITY/STATE/ZIP <br /> O7 S �/iso S-toek-b,.j C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? APs COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER # PER # PER # PER # PER # <br /> '10—N 64-msvx.l �Y� 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 V <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 A _ <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 116 <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 27 128 1 <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 <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 <br /> IMPROPER ABANDONMENT 55 56 -' <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �•�j G^. s dG SQe <br /> urIC <br /> 59 <br /> MAJOR a MINOR E] NO <br /> VIOL. VIOL. VIOL <br /> OFFICE: INSP- RECEIVED BY: <br /> C%rll� hN� <br /> TITLE: .QCIf$ PHONE: BECK: <br /> HUT-3 ORIGINAL �� OM <br />