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UNDERGROUN 'ANK PROGRAM OFFICIAL INSPF` - ON REPORT <br /> _AN JOAGUIN HEALTH DISTRICT / <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME 1 STOCKTON, CA 95205 COUNTY #SE/9Rca�- <br /> SQ/rJ .�-Da u.c.+ti PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> Co oe.4ex- fr'uGfYin <br /> SITE ADDRESS: �a / IV. (fa,'j ale- CITY/STATE/ZIP SfKn <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK b TANK 0 ,P- TANK d 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF�IN-S1PECTION SITE COMPUTER# NUMBER/(,99& NUMBER/&f6 NUMBER/(v/LO NUMBER <br /> '\ ©O/ �� PER# PER# PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENT <br /> MAJOR I 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 3334 <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: 5e Q K1 Q 44 Q. <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL IYJ VIOL ❑ VIOL❑ <br /> OFFICE: INS /�_ / RECEIVED BY: <br /> TITLE: S .f f(��p�� PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 © <br />