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` UNDERGROUN ANK PROGRAM OFFICIAL INSP ON REPORT <br /> �AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. + <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 5 <br /> PHONE NO. 468-3423 <br /> SITE NAME: 6i✓ s�K✓��� INSPECTION DATE.-7/2, <br /> SITE ADDRESS: ����1 �� CITY/STATE/ZP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ' COMPUTER 71 COMPUTER COMPUTER <br /> TYK OF INSPECTION SITE COMPUTER# NUMBER 166 0 NUMBER�Q NUMBER NUMBER <br /> �j PER # ge/f 9a' PER# � A000 PER # PER# <br /> 1 I EXP.DATE // EXP.DATE r EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS " <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE -14 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 1 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 130 <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 45 - <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 TEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLO a" <br /> 7 58 59 � AL� � <br /> MAJOR MINOR NO e _ <br /> VIOL. VIOL. ❑ VIOL❑ O <br /> OFFICE: INSP: RECEIVED BY:o�j DFNnIs D f 1,^ iN <br /> i C <br /> TITLE: f J PHONE: PECK: <br /> HUT-3 ORIGINAL 5i88 OM <br />