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UNDERGROANK PROGRAM OFFICIAL IN ION REPORT <br /> AN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # �l <br /> PHONE NO. 468-3423 <br /> SITE NAME: U INSPECTION DATE: 7k�7���� <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> � ��t <br /> fC tU U <br /> CHANGES SITE/OWNER/PERMIT? ES' NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER�� COMPUTER COMPUTER COMPUTER <br /> TX.QE OF IN-S,P,EECTIION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER # PER # PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 A� <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 m <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 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 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 ITEMS REPRESENT VIOLATION AND MUST BE CORRECTED <br /> --Ay�S&---- <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: a 14'' C57 58 59Z <br /> MAJOR MINOR NO <br /> VIOL. VIOL. VIOL.LJ <br /> OFFICE: l INSP:� �n RECEIVED BY: <br /> TITLE: ����� PHONE: BECK: <br /> rIUT-3 ORIGINAL 5/88 ON <br />