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UNDERGROUVTANK PROGRAM OFFICIAL INSPEr"'ON REPORT <br /> AN JOAQUIN HEALTH DISTRICTS j <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 5 <br /> PHONE NO. 468-3423 a <br /> SITE NAME: A�� /,t - I dS �� INSPECTION DATE: <br /> / NI 6 <br /> SITE ADDRESS: � STATE/ZIP 8vS)/ /45� CA c/ �3 7Z <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ( TANK ![ TANK FEXP. <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER UTER <br /> NUMBER '000 NUMBER NUMBER ER <br /> TYP OF INSPECTION SITE C MPUTER # <br /> u I !J 9�i 0 PER# �N PER# II PER # <br /> T( I EXP.DATE EXP.DATE EXP.DATE ATE <br /> OPERATIONAL TANKTANK CONTENTS <br /> _ MAJOR MINOR <br /> PERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE ---- <br /> APPROVED CONSTRUCTION 5 16 1v� <br /> WRITTEN MONITORING PROCEDURES 7 18 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 �) - <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 .F <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 _ <br /> INVENTORY RECONCILIATION - 21 22 <br /> TANK GAUGING 23 X 24 _ <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPUNG 29 30 ------ -- <br /> APPROVED TANK REPAIRS 31 32 4 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATEDIVA <br /> 37 <br /> I <br /> TEMPORARY TANK CLOSURE <br /> S Z+N'F <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> �I <br /> 7 <br /> PERMANENT TANK CLOSURE � " M0 ': 7p.r,$y��::� <br /> ON <br /> REMOVAL OF RESIDUAL MATERIALS r5556 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED _ <br /> UNAUTHORIZED RELEASE 52 G� Q <br /> SAMPLING 54 ec( ! � /J� ✓"__-_�� <br /> IMPROPER ABANDONMENT 'P <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUSTBECORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: K <br /> 0 I 1 o R <br /> MAJOR ($�7 MINOR 58 NO 59 /S � „$" S JX' l <br /> VIOL ,LV VIOL ❑ VIOL❑ $^T /ZT lG <br /> Gift 2 �l <br /> O Y?zV 1 'e L./ <br /> OFFICE: INSP: RECE D <br /> TITLE: Z'6e PHONE: RECK: <br /> 2v <br /> HUT-3 ORIGINAL <br /> i siea OM <br />