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UNDERGROU' SANK PROGRAM OFFICIAL INSP" <br />N JOAQUIN HEALTH DISTRICI <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />TION REPORT <br />COUNTY # Zl' <br />SITE NAME: <br />alt--- _TC keno-- <br />INSPECTION DATE/p- Z <br />SITE ADDRESS: 1 <br />2 NT CITY/STATE/ P <br />G <br />SZ6 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK <br />TANK ?i <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBS DO � <br />PER #v�L <br />COMPUTE?- O <br />PER # R''��� 0 <br />PER # A i ec�Qj, <br />COMPUTER <br />NUMBER <br />PER # <br />COMPUTER <br />NUMBER <br />PER # <br />TYPE OF INSPECTION/ <br />SITE COMPUTE # ^ <br />�L//�� <br />[/� <br />((LJ <br />EXP. DAT <br />EXP. DA <br />EXP. DATE <br />EXP. DATE <br />OPE MONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />- <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />_ <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />_ <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />130 <br />1_ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />_ <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />V,11, 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />9 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W <br />7 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPUNG <br />` <br />54 <br />_ <br />-- <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJOR MINOR NO <br />ElVIOL. ❑ <br />VIOL. VIOL. <br />OFFICE: <br />INSP <br />�a <br />EIVED <br />2�� <br />PHONE: <br />PECK: <br />TITLE: �, <br />HUT -3 ORIGINAL <br />