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UNDERGROUNLI TANK PROGRAM OFFICIAL INSPE('-'7N REPORT <br /> ,N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. ➢ <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # -Z <br /> PHONE NO. 468-3423 < <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: /,,/ CITY/STATE/Zlg70 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANKTANK 0 TANK 00 <br /> FORM A AND/OR B SUBMITTED? COMPUTER D B COMPUTE COMPUTER p0 COMPUTE J <br /> NUMBER/ NUMBERm, NUMBER NUMBER ^ l,-1v <br /> TYPE OF INSPECTION SITE COMPUTER# l Q r / ` �� V <br /> PER# � � PER # s �v PER# PER# <br /> l A 4, EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNreNrs _ <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 18 <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 37FA <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 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 ME <br /> UNAUTHORIZED RELEASE 51 52 L Q,Fr O �+ <br /> SAMPLING 53 54 g vJ V r^ y q 644 l <br /> IMPROPER ABANDONMENT 55 56 s �/ <br /> Z S THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) 6,J MQ fp/�� FOLLOWS: e Es N 1-roe, O (6/Q,s� 05- <br /> o o d"b <br /> 57 58 59 D X, <br /> MAJOR ❑ MINOR ❑ NO <br /> VIOL. VIOL. VIOL. p_i�Z_GC S r D_ <br /> OFFICE: INSP: RECEIVED BY: <br /> �>4 U A <br /> TITLE:r7_eoT PHONE: � RECK: <br /> HUT-3 ORIGINAL 5/S8 n' <br />