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UNDERGROUND"' NK PROGRAM OFFICIAL INSPEC`)N REPORT <br />N JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />P��Lo,c Z <br />39 <br />SITE NAME: <br />INSPECTION DATE: I - I <br />-- <br />Deur_�L� <br />SITE ADDRESS: 7 <br />"3,;'bo <br />)<OV:55 0 t,,) <br />CITY/STATE/ZIP -7 <br />-7 <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK <br />TANK Ly <br />TANK 57 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />"NUMBER t4AJ4� <br />COMPUTEROMPUTER <br />NUMBER <br />NUMBE 40 <br /># <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />PER <br />PER # <br />PER <br />EXP. DATE <br />XP. DATE LA6 S <br />mpl6v#&Ipf_ <br />OPERATIONAL TANK <br />TANK CON�NTS <br />_MA_J0_RJ <br />w", <br />T, <br />MIN—OR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />APPROVED CONSTRUCTION <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />+4 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />16 <br />ACCESS CASING SECURED <br />1� 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />2 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 45 <br />5 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50m <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />7 58 <br />59 <br />MAJOR MINOR NO <br />LJ LJ <br />VIOL. VIOL VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PHONE' <br />BECK: <br />HUT -3 ORIGINAL <br />