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UNDERGROUN^ TANK PROGRAM OFFICIAL INSPF'TION REPORT <br /> —3AN JOAQUIN HEALTH DISTRICT _ <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # q <br /> PHONE NO. 468-3423 3 <br /> COUNTY NAME <br /> SITE NAME: rs INSPECTION DATE: lel �po <br /> SITE ADDRESS: 3 3� rQ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER S1 yj S'TN NUMBER ay IS-p MBER NUMBER <br /> d u PER# PER # PER# PER# <br /> 7Cank rel--no� a7�� EXP DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK TANK MAJORRMlNOR G-fS / 000 9 5 <br /> MIV(7 C7 <br /> PERMIT TO OPERATE 1 2 :s�)/✓P i7 f `L-, <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 /> 7 -- <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 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> ERMANENT TANK CLOSURE <br /> REMOVAL OF 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> ED RELEASE 51 52 <br /> SAM 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: Z rr a 4'�w k-T <br /> MAJOR 0 MINOR NO 58 LJ- <br /> VIOL. VIOL VIOL <br /> OFFICE: INSP: oZ RECEIVED BY: <br /> TITLE: /" -f[ ,S _ PHONE: y!��3 6 & RECK: <br /> HUT-3 ORIGINAL siee OM <br />