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UNDERGROUP TANK PROGRAM OFFICIAL INSPf TION REPORT /GiGfia pL� <br /> -SAN JOAQUIN HEALTH DISTRICTS oQ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKON, CA 95205 <br /> PHONE TNO. 468-3423 CUIINTY # <br /> SITE NAME: <br /> INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIR�r*r6r <br /> 6 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK !1 TAN /FORM A AND/OR B SUBMITTED? COMP R Y COMP F( R <br /> TYP OFINSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER PER# PER# PER#5 EXP.DATE EXP.DATE EXP.DATE E <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJORMINOR <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 1p <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 T <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPUNG 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 3b <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED -- ---- <br /> ACCESS LOCATIONS SEALED -- <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING48 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 VIO TIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 9 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: (��1�� RE�D BY: <br /> TITLE: �n� � / PHONE: ECK: <br /> HUT-3 ORIGINAL siae OM <br />