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UNDERGROUN SP ON REPORT / oG Z-- <br /> �AN JOAQUIN HEALTH DISTRICT <br /> PROGRAM OFFICIAL INICT _ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: �T'o 7- 7JpN,gL iY✓L INSPECTION DATE: G <br /> SITE ADDRESS: �gZ,/n Av CITY/STATE/ZIPS7 gjlZ�� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKTANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUT(/R COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK RTMI CONTENTS <br /> MAJOR MIR <br /> R <br /> PERMIT TO OPERATE 1 2 <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 /> INVENTORY RECONCILIATION 21 122 <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 /> _ <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING - 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESJ= T V� TIONS ND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: " <br /> MAJOR 57 MINOR 58 NO `59 <br /> VIOL LJ VIOL ❑ VIOL K <br /> 19 <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> ©M <br /> NUT-3 ORIGINAL siaa <br />