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UNDERGROUN N JPROGRAM OFFICIAL OAQUIN HEALTH DISTRICT E�ON REPORT tor, 3 <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205. COUNTY # <br /> CQUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: (AIN�RD f A"9 # qj'S-Ai Lp INSPECTION DATE: <br /> SITE ADDRESS: 6'6 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK 6 TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER oO NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# It PER # PER# PER # <br /> /" a 1 EXP DATE EXP DATE EXP.DATE EXP.DATE <br /> MAJORR MI <br /> OPERATIONAL TANK TANK MNTS <br /> NOR <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 L37 <br /> _. _... <br /> INVENTORY RECONCILIATION -- <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4142 <br /> 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED 43OWNER/OPERATOR MONITORING 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 /> SAMPUNG 53 _ 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUSI BE CORRECTED S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: R PHONE: RECK: <br /> NUT-3 ORIGINAL siva OM <br />