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UNDERGROUK" TANK PROGRAM OFFICIAL INSPF^TION REPORT <br />,„SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME �p/'' STOCKTOO. CA 95205 COW # ? Q <br />D lt' PHONE NO. CA 95 0 J <br />SITE NAME: J & C K 7 D '�- <br />INSPECTION DATE: <br />SITE ADDRESS: J Jf �C CITY/STATE/ZIP <br />c <br />CHANGES SITE /OcWNER/PERMIT? YES <br />NO <br />TANK TANK 6�11, <br />TANK b>3 <br />TANK p�/ <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTER <br />COMPUTE <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # PER # <br />PER # <br />PER # <br />--,, <br />rom"a.e �� <br />✓cc <br />EXP. DATE W. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TANKCONIENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />_ <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />118 <br />r <br />_ <br />PIPING 19 <br />20 <br />INVENTORY RECONCILIATION 21 <br />22 <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 133 <br />134 <br />SAFETY HAZARD 135 <br />136 <br />_ <br />CONDITIONS ABATED <br />37 VA <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 <br />POWER DISCONNECTED <br />r45 <br />OWNER/OPERATOR MONITORING 44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />47 <br />PIPING <br />49 <br />FLAMMABLE VAPORS REMOVED <br />P�5-5- <br />UNAUTHORIZED RELEASE <br />52 <br />SAMPLING <br />54 <br />IMPROPER ABANDONMENT <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: IX <br />57 5B 59 <br />MINNO <br />LJ ❑ ❑ <br />VIOLOR VIOL. VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/W 01 <br />