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UNDERGROIlp SAN JOAQUIN HEALTH D STRIOFFICIAL �TION REPORT <br />C <br />�� 1601 E. HAZELTON AVE <br />STOCKTON, CA 95205 COUNTY # <br />COUNTY NAME PHONE NO. 468-3423 <br />r , <br />I siaa <br />HUT -3 <br />INSPECTION DATE: <br />c�fr <br />SITE NAME: / G �•/ <br />CITY/STATE/ZIP <br />SITE ADDRESS: �. GoPZ <br />� YE. <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO TANK W- <br />TANK TANK <br />COMPUTER COMPUTER <br />TANK <br />COMPUTER <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />NUMBER NUMBER <br />NUMBER <br />TYpPE INSPECTION SITE COMPUTER # <br />PER # <br />PER # PER # <br />PER # <br />�OF <br />EXP- DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />nwKcoNRN1sNO <br />MAJOR MIR <br />PERMIT TO OPERATE <br />1 <br />2 _ <br />----" -- <br />- -- -- <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 />APPROVEDMONITORINGSYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16- <br />- <br />ACCESSCASINGSECURED <br />17 <br />18 <br />...-- --- -- <br />""- <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22TANK <br />GAUGING23 <br />24 <br />- <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING <br />29 <br />30 <br />--- <br />- <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />---- - <br />- <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />-. -- <br />- <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />36 <br />- <br />FLAMMABLE VAPORS REMOVED <br />40 <br />-- <br />ACCESS LOCATIONS SEALED <br />41 <br />P457�-�f <br />---- <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />__..-- --"--- - - <br />- <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />--'— <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />-- <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />6C ��o <br />�' 19,46C <br />SYSTEM STATUS ((MUST MARK ONE) <br />FOLLOWS: <br />' <br />OR 5 <br />MAJOR - V MINOR E] <br />NO 59 <br />VIOL. ❑ <br />VIOL. LJ VIOL <br />OFFICE: <br />INSP: )5w"- r�i5( <br />:REC:EIVED BY: <br />TITLE: /^ •�/j/ s <br />Ne !/68_ 03YJ'3 RECK: <br />I siaa <br />HUT -3 <br />