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■ <br /> 1 UNDERGRO' "'D T7NK PROGRAM OFFICIAL INSr-FC7"ON REPORT <br /> N JOAQUIN HEALTH DISTRR <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: I.-A k I-) INSPECTION DATEz-/3 <br /> SITE ADDRESS: C I i Y CITTE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK _ TANK TA/NK b <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> TYPE INSPECTION SITE COMPUTER# <br /> NUMBER�00O NUMBER NUMBER NUMBER <br /> PER# PER# 666 G PER# PERLk # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE I <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 g <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 j <br /> APPROVED RESPONSE PLAN 25 26 v <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> ------------. <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED FX, 37 { <br /> TEMPORARY TANK CLOSURE I <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 <br /> THE MARKED ITEMS REPRESENT VIO TIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: v `� S C f <br /> MAJOR 57 MINOR 58 NO 59 ' <br /> VIOL ❑ VIOL. ❑ VIOL <br /> OFFICE: INSP:Wk�,�� <br /> RECEIVED BY: <br /> TITLE: (7 � ��y�L-� PHONE: BECK: <br /> HUT-3 J ORIGINALl� �`/ 5/88 0" <br />