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UNDERGROUNr �IkNK PROGRAM OFFICIAL INSPEf -'ON REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: A� G� f�i L .4 <br />6100 <br />7-1-1Z1- <br />INSPECTION DATE: 17 -1 -1Z1 -'?A <br />SITE <br />SITE ADDRESS: --77,' <br />(&55 <br />CITY/STATE/ZIP f� � <br />C�j3 >�CHANGES <br />Tt <br />5u <br />SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK /7 <br />TANK <br />TANK 9 <br />TANK ,/ <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />PER # �� n(�) h <br />uV _ U <br />PER# <br />COMPUTER <br />PER # �ol� <br />PER# � � <br />COMPUTER <br />PER # 1(7I <br />PER#(0�d�� <br />COMPUTER <br />PER # �Q <br />PER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />�/�% <br />b// <br />� <br />/ \U���N� <br />, 0 <br />EXP. D (/ <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />i <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />VZI, <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />2 OjCo <br />/e <br />58 <br />MAJOR 57 MINOR NO <br />❑ 11 <br />59 <br />M <br />VIOL. VIOL. VIOL. <br />/17 <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />d <br />rG3� <br />TITLE.5 f i Z'cc; <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />