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UNDERGROI lNW PROGRAM OFFICIAL INSr'c'-';14N REPORT <br /> AN JOAQUIN HEALTH DISTRIG..,,. ) <br /> 1601 E. HAZELTON AVE. <br /> .,d STOCKTON, CA 95205 COUNTY #. <br /> COUNTYRAME's PHONE NO. 468-3423 <br /> SITE NAME: � INSPECTION DATE: <br /> w SITE ADDRESS: 1 ��3 � Q/S CITY/STATE/ZIP&6, <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKTANK n TANK ( TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER /C✓ COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTIIONn SITE COMPUTER# PER # PER# PER # PER #- <br /> 1 <br /> // ,5L? EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS ' ".. ' `'? ��" 1 <br /> OPERATIONAL TANK <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 _ I <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 /> P{JWFR DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE yLq , <br /> . REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> P#PING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> t <br /> SAMPLING 53 54 <br /> Ih1PROPER ABANDONMENT 55 56 <br /> THE-MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CO�R'RE/CTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: l �f'� <br /> MAJOR 57 MINOR 58 NO 59 - -- -- -- -- <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> t � <br /> I <br /> TITLE_: QE� [' PHONE. BECK: <br /> ' l J I <br /> I-II IT nr�lrinlal s, R O, i. <br />