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UNDERGROUNrl TANK PROGRAM OFFICIAL INSPE' TION REPORT <br />,AN JOAQUIN HEALTH DISTRICT rt <br />i1601 E. HAZELTON AVE. <br />STOCKTON,CA 95205 COUNTY # <br />COUNTY NAME <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: <br />t OGS <br />I <br />SITE ADDRESS: Z 2 SQ 6 <br />cf d� <br />CITY/STATE/ZIDr <br />J <br />616- /{, <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK 3 <br />TANK <br />V/v <br />TANK <br />COMPUTE <br />TANK <br />COMPUTER <br />FORM A AND/OR B SUBMITTED? <br />COMPUTEI <br />COMPUTER <br /># <br />NUMBE& ..�.� <br />LD(!V_l <br />AE <br />NUMBER , o <br />NUMBER 3 <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER <br />PER # ^ / <br />PER # <br />PER # K <br />PIER # <br />JZ Gt <br />EXP. DATE <br />EXP. DATE <br />EXP. DATES eq <br />TE <br />OPERATIONAL TANK <br />TANK CONI N 5 <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />_ <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />_ <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />_ <br />TANK GAUGING <br />23 24 <br />_ <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />_ <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />_ <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W"45 <br />POWER DISCONNECTED <br />_ <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 <br />59 <br />MAJOR MINOR NO <br />❑ <br />❑ <br />VIOL VIOL VIOL <br />OFFICE: <br />INSP:RECEIVED <br />BY: <br />TITLE:fey5 <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 51W OI <br />