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UNDERGROUNC ANK PROGRAM OFFICIAL INSPEC"ON REPORT <br /> AwAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME RIS o��p <br /> SC1M -OQ PHONE NO. 468-3423 <br /> SITE NAME: /la re Aa INSPECTION DATE: /OP vier <br /> SITE ADDRESS: o /_ &,), AlW( 7�V 60 CITY/STATE/ZIP S f C14 pj aa5 <br /> CHANGES SITE/OWNEUR!/PERMIT? YES NO TANK b / TANK a- TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER/3Q/y NUMBER 13NUMBER NUMBER <br /> TYPE OF IJECTION SITE COMPUTER# PER# PER# PER# PER# <br /> D © /3 b(o EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK R MINOR <br /> IN R <br /> MAJOR MINOR <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 16 <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 V56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) F LLOWS: <br /> MAJOR 57 MINOR NO <br /> VIOL VIOL. VIOL. <br /> OFFICE: INS//PN�y��:: RECEIVED BY: <br /> TITLE: _�alrA PHONE: BECK: <br /> HUT-3 ORIGINAL siea OM <br />