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UNDERGROUN NK PROGRAM OFFICIAL INSPE ON REPORT <br /> ,WN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. c� <br /> STOCKTON, CA 95205 COUNTY # J <br /> COUNTY NAME PHONE NO. 468-3423 <br /> FSITENAME: �� INSPECTION DATE: -"_--�f3 s-�/ L, <br /> RESS: S N1tC L/�/t� y'yTY/STATE/ZIP -u G — l'f �/ G <br /> CHANGES SITE/OWNER/PERMIT? YES NQ TANK - �� TANK Ie. <br /> t <br /> TANK <br /> COMPUTER t[ COMPUTER COMPUTER COMPUTER <br /> FORM RAND/OR R SUBMITTED? <br /> NUMBERS 67- - NUMBER NUMBER NUMBER <br /> TYPE OF G li�1d$PSITE COMPUTER# PER# PER # <br /> PER# PER# <br /> 7 / -3 EXP.DAT P. ATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK MAJQR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 ¢ <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 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 j39jl� <br /> - - <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 ITE�lIS REPRESENT VIOLATIQNS AND MUST BE CORRECTED,,AS <br /> �� <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS- <br /> MAJOR 57 MINOR 58 59 <br /> NO �( <br /> VIOL. ❑ VIOL. ❑ VIOL. - <br /> C <br /> OFFICE: IN P- RECEIV D BY: <br /> 1 <br /> 10 <br /> `7 1 c')Z <br /> TITLE: 6J] HONE: BECK: <br /> HUT-3 ORIGINAL <br />