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UNDERGROUANK PROGRAM OFFICIAL INSP ION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 F. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> G± II <br /> SITE ADDRESS: H OC 1 �oh CITY/STATE/ZIP I-IZ94 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p ' TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTION ]SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> S( ,Q� PER # PER # PER# PER# <br /> U i e-- �6*� EXP DATE EXP. DATE ['XP DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS ,/7 yyyy, <br /> MAJOR MINOR C9©6b <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 11 112 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> -- --- _ <br /> INVENTORY RECONCILIATION 21 22 _ <br /> TANK GAUGING 23 24 av -rr i Yds-7/' czr� r ± <br /> APPROVED RESPONSE PLAN 25 26 € �-- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 T <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 ^ <br /> ACCESS LOCATIONS SEALED 41 42 - <br /> POWER DISCONNECTED 43 _ <br /> OWNER/OPERATOR MONITORING 44 145 <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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP• RECEIVED BY: / <br /> CiG ,QC � - - - - <br /> TITLE: ,/)�17L-5 . PHO E: � � BECK: <br /> HUT-3 ORIGINAL <br />