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} M1 <br /> UNDERGROUPwoo�TANK PROGRAM OFFICIAL INSPI: ION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME -I STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 l <br /> SITE NAME: r}`"� ,^���y� L . K �'C INSPECTION DATE: 3 1 1 6 <br /> SITE ADDRESS: 0 c k c z'Y CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMSER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTE�H # PER # PER# PER # PER# <br /> 1�e)CCc1 llG-y.� I EXP.DATE EXP.DATE EXP DATE EXP.DATE <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 13 114 <br /> MONITORING RECORDS MAINTAINED U24 <br /> 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 O <br /> TANK GAUGING ■ <br /> APPROVED RESPONSE PLAN 25 126 <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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CCRREC I ED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:_-- <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: — — INSP RECEIVED BY: — - <br /> - - - --------- -- - _... --- <br /> TITLE: S PPHONE I,LGK <br />