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C UNDERGROUNVANK PROGRAM <br /> _ AN JOAQUIHEALTH DIAL STRICI ION REPORT <br /> COUNTY NAME ,,J . 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> SITE NAME: PHONE 468 <br /> NO. -3423 <br /> - rn An CUNNTP # <br /> SITE ADDRESS: /STgTE <br /> CITY INSPECTION DATE: f! <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK <br /> FORM A AND/ B SUBMITTED? /ZIP <br /> TANK <br /> T PE OF INSPECTIQN �� COMPUTER TANK <br /> SITE COMPUTER# NUMBER COMPUTER COMPUTER TANK <br /> PER# NUMBER NUMBER COMPUTER <br /> ER <br /> P # <br /> OP RATIONAL TANK EXP.DATE PER# NUMBER <br /> TANK CONIENTS EXP.DATE PER# <br /> PERMIT TO OPERATE MAJOR MINOR ,_ EXP.DATE <br /> EXP.DATE <br /> CHANGE IN CONDITIONS TO OPERATE 1 2 <br /> 3 4 <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES 5 6 <br /> APPROVED MONITORING SYSTEM 7 8 <br /> MONITORING SYSTEM 10 - -.- <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> 111 12 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING <br /> 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 /> .._---�-- <br /> APPROVED TANK REPAIRS 31 32 - -- <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> —_....______i <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> - - <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 <br /> FLAMMABLE VAPORS REMOVED 39 <br /> ACCESS LOCATIONS SEALED 40 ' <br /> POWER DISCONNECTED 41 42 <br /> 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> - - -- <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS <br /> PIPING 46 47 _ <br /> FLAMMABLE VAPORS REMOVED 48 49 _ <br /> 5 <br /> JNAUTHORIZED RELEASE <br /> iAMPUNG 511 <br /> 52 <br /> DROPER ABANDONMENT 53 54 <br /> 55 56 <br /> 1EM STATUS(MUST MARK ONE) THE MARKE TEM REPR SENT VIO TIONS AND MUST BE CORRECTED AS <br /> OR 57❑ MN R El 59 FOLLOWS: <br /> NO 9 <br /> VIOL. VIOL <br /> INSP: <br /> �9�_. RECEIVED BY: <br /> TITLE: PHONE: <br /> PECK: <br /> ORIGINAL <br /> sraa © <br />