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OFFICIAL INSPE <br /> UNDERGROU AN JOAOUINA HEALTH DISTRICT <br /> WON REPORT <br /> �5 1601 E. HAZELTON AVE. <br /> �f STOCKTON, CA 95205 COUNTY # 3�j <br /> COUNTY NAME Sap, JQo Ula IA CAA PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 6 Al /i^r <br /> SITE ADDRESS: 7 I t, U CITY/STATE/ZIP <br /> M, A,4 C • <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK d/ TANK O TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION p SITE COMPUTER# PER # PER# PER # PER # <br /> T H RPI mwLC 2 3 c'/ 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 <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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL P43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS RK- <br /> - <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED .._. - ------UNAUTHORIZEDRELEASE SAMPLING .----------'_IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 <br /> IOL R LJ 58 59 <br /> V ❑ VIOL.❑ <br /> OFFICE: INSP: C4,0es 4;; RECEIVED BY: <br /> TITLE: Eh(sy PHONE: RECK: <br /> 5/88 O, <br /> HUT-3 ORIGINAL <br />