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UNDERGROUN ANK PROGRAM OFFICIAL INSIDE ON REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME S ' STOCKTON, CA 95205 COUNTY # jq <br />C(� J� 4//F) PHONE NO. 468-3423 <br />HUT -3 ORIGINAL 5/88 ©I <br />SITE NAME: S G. <br />INSPECTION DATE: / Z <br />SITE ADDRESS: 5. SO •v se- <br />CITY/STATE/ZIP <br />R1 N <br />9536.4 <br />CHANGES SITE/OWNER/PERMIT? YE NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED?�� <br />COMPUTER / <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />sl-c©�-J !f / <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />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 />_ <br />APPROVED MONITORING SYSTEM 9 10 <br />MONITORING SYSTEM 11 12 <br />_. <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 />,.., <br />APPROVED RESPONSE PLAN 25 126 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br />SAMPLING 29 30 <br />APPROVED TANK REPAIRS 31 32 <br />_ <br />UNAUTHORIZED RELEASES REPORTED 33 34 <br />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />a <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 9 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W44457 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <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 />- <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: S S <br />!57 <br />n13 <br />fav <br />58 fig/ <br />MAJOR MINOR❑ NO I�/1 <br />. VIOL. VIOL. VIOL. LI <br />OFFICE: <br />INSP: yr <br />(,iutiU <br />RECEIVED BY: <br />TITLE:R#S <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 ©I <br />