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UNDERGROUND ' NK PROGRAM OFFICIAL INSPECT"'N REPORT <br /> 1 JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 37 <br /> PHONE NO. 468-3423 <br /> SITE NAME: X Lt7 S O GI C-70 ✓ INSPECTION DATE: :-- <br /> SITE ADDRESS: i_} w C/kp,�_(_� CITY/STATE/ZIP �jG{���r� t-7 )'&6,6 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK -1 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE <br /> TYPE�F INSPECTION SITE COMPUTER# NUMBEFI-6 000 NUMBERl0�0Q0 NUMBEI0Op0 ctA NUMBEFj2,00o <br /> �—�,, PER# �D��$�� PER# ER# 0/ PER# / r ' <br /> I% U l(o W— U? d S EXP.DATE EXP.DATE EXP.DATE / EXP.DATE v <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 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 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 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 _ <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE C RRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: `-� S 'v O "I lj5v <br /> I b iJ ` Q <br /> MAJOR 57 MINOR 58 NO 9 10 Zvi r 0 "j"-c <br /> VIOL. ❑ VIOL. ❑ VIOL. 09 lea $cam 5"' 9 <br /> I <br /> OFFICE: INSP: RECEIVE B . <br /> X <br /> TITLE: PHONE: RECK: <br /> 7� <br /> alae <br /> HUT-3 ORIGINAL O <br />