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�o <br /> UNDERGROU ',NK PROGRAM OFFICIAL INSP -nON REPORT <br /> AN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME J PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: ( /n -� INSPECTION DATE:3--/6-J2 <br /> SITE ADDRESS: Q n . &5h� J <br /> / CITY/STATE/ZIP V <br /> CHANGES SITE/OWNER/PERMIIT`?� YES NO ANK QS TANK 0& TANK 0:7- TANK O <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER- <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP F INSPECTIO SITE C IJ�TER# PER# PER# PER# PER# <br /> l/f EXP.DATE" EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK ',� �fi :; • ' `fi'"� . <br /> MAJOR MINOR v:?.m"' s:�. S 'a°.., v^r `-,::"R� ;'`. '¢' t;r ariwa-. ...•>: ++ !..cc?kv�' <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 16 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 F <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 X <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> N JN-5,04TEMPORARY TANK CLOSURE `a�`� �t ��. <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 /> RE F RESIDUAL MATE 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 REPRES NT VIOLATIONS AND MLLST BF-CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL El VIOL LJ VIOL <br /> OFFICE: INSP �DGC%�/ RECEIVED BY: <br /> TITLE: � ���� PHONE: RECK: <br /> R6. f <br /> HUT-3 ORIGINAL s,ea OM <br />