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UNDERGROUN'='-TANK PROGRAM OFFICIAL INSPEC''"ON REPORT <br /> ,,AN JOAQUIN HEALTH DISTRI( <br /> / 1601 E. HAZELTON AVE- \oof <br /> COUNTY NAME STOCKTON, CA 952.05 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: / INSPECTION DATE: as <br /> c.f C /n <br /> SITE ADDRESS: 3 CITY/STATE/ZIP fG <br /> CHANGES SITE YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSP CTION SITE COMPUTER# <br /> e do�_- � PER PER# PER# PER# <br /> s h2 p ���o EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 8 _ <br /> APPROVED MONITORING SYSTEM 9 10 _ _ - <br /> MONITORING SYSTEM 11 12 - <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 - <br /> PIPING 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 /> APPROVED TANK REPAIRS 31 32 - _ - <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 /> REMOVAL OF RESIDUAL MATERIALS 46 147 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 - <br /> SAMPLING 53 54 -- <br /> IMPROPER ABANDONMENT 55 56 T <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: c rriY�_31(^e4i _�� <br /> 57 58 59 / � a.0r�C)_q� - <br /> MAJOR ❑ MINOR ❑ NO 1771", �i�• ,�1�G�-b��Jy�{e_t O'd at�[0 <br /> VIOL. VIOL, VIOL LLL!!!g <br /> OFFICE: INSP: 0-aYfl RECEIVED BY: <br /> TITLE: IF H, -Sr PHONE: 7 b r3 - 7 BECK: <br /> HUT--3 ORIGINAL V •J Y jf liars U <br />