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Irl <br /> UNDERGROUND NK PROGRAM OFFICIAL INSPE(W REPORT <br /> 1 JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> 1 PHONE NO. 468-3423 <br /> INSPECTION DATE:f�-LSITE f JG*- 774 ce i <br /> SITE ADDRESS: •�', CITY/STATE/ZIP f��U �� J,) )-, <br /> Gam. ANTLi NG <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK _? TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER, 4 COMPUTER COMPUTER OMPUTLR <br /> TYP OF INSPECTION SITE COMPUTER# NUMBER f OX" NUMBER 041') NUMBER aoo UMBER <br /> k� 'T / PER # PER # '6� �� PER # v�' PER # <br /> i6oe'�Ive �f I'IS c" EXP.DATE EXP.DATE �` EXP.DATE uN EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 x <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 VA 37 <br /> b <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) U �i <br /> FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINORNO <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP:/� <br /> TITLE: PHON ECK: <br /> HUT-3 ORIGINAL 5/88 81 <br />