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UNDERGROUN; TANK PROGRAM OFFICIAL INSPE —TION REPORT <br />_AN JOAQUIN HEALTH DISTRICT _ <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: < /�) ���5 Or� � INSPECTION DATE: 7 P f <br />!� <br />SITE ADDRESS: <br />svo CITY/STATE/ZIP 74 <br />CHANGES SITE YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK 63 <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE INSPECTION <br />QO rlAG <br />SITE COMPUTER # <br />p <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTs <br />)) <br />L. S L 4o <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />35 36 <br />/ 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />M11111111110 <br />o <br />n�0 <br />47 <br />49 <br />52 <br />SAMPLING 153 154 _.. . <br />IMPROPER ABANDONMENT 155 156. <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />��G 4 <br />57 <br />MAJOR MINOR 58 59 <br />NO <br />VIOL. LiVIOL. 11 VIOL. <br />OFFICE: INSPL/- < RE I D BY. <br />TITLE: a� H NE: RECK: <br />HUT -3 ORIGINAL 5/88 01 <br />