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UNDERGROUN"ANK PROGRAM OFFICIAL INSPEf TION REPORT <br /> ,,AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. 'I <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: -X07 »r/tc INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> L �Q PER # 1 L1 3y'-O PER# l y?Y-O ER# PER# <br /> /7L !eiI't0✓""� �y-3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS '. 4 <br /> MAJOR MINOR " ""'""�� '•' ' <br /> v <br /> I i3 y:. .;; .;z ar <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORINGT 11 12 <br /> APPROVEDEDMONITOR <br /> 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 Oil <br /> W <br /> 1 1, 3 Yt Nlr 'd' <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 m <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 43 . .. ..... _ .. .... <br /> OWNER/OPERATOR MONITORING 44 45 ...... _..... __.... <br /> PERMANENT TANK CLOSURE i `INN, r <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 —561 1 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: '/—' <br /> .f <br /> Le- 7�" O CCGi G��f COI <br /> MAJOR 57 MINOR 58 NO 59 - " <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: n _�l Q Z— RECEIVED BY: <br /> TITLE: �[ PHONE: BECK: <br /> HUT-3 ORIGINAL sine ©, <br />