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/ UNDERGRO(W TANK PROGRAM OFFICIAL INS CTION REPORT <br /> ! SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> U i S a7 _ a <br /> f <br /> SITE ADDRESS: �Oax N Ga /f Lo G CITY/STATE/ZIP A. gSZar <br /> r vr� t �G,E � h r <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER GCOMPUTER COMPUTER <br /> TYPE OF IN$$gqECTI N - SITE COMPUTER # NUMBER p6 'V NUMBER (o ` NUMBER NUMBER <br /> /r0 :e / / PER # 2ya PER # �.qg PER # �.NU ` / PER # <br /> C;) Ylrb EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK ' • <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES . . 7 • V 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM - - 11 V 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED - 15 15 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING - . . - - 19 20 <br /> INVENTORY RECONCILIATION 27 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 - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD - - _ 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 - <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> RE1 I 'LL <br /> MOVAL OF R 46 47 <br /> PIPING - - - 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE _ 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT - - 55 56 - - - - - - <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS (MUST MARK ONE) - FOLLOWS: ^ <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL VIOL ❑ VIOL ❑ - <br /> OFFICE: INSP: � l 07 RECEIVED BY: <br /> TITLE. �EHS PHONE: PECK: <br /> (1&r - 3 Y6fi <br /> HUT-3 ORIGINAL 5i8B OM <br />