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UNDERGROW"' TANK PROGRAM OFFICIALlNSP''�'TION REPORT , <br /> -SAN JOAQUIN HEALTH DISTRICT.' ' <br /> 1601 E.'HAZELTON AVE. <br /> COUNTY NAME2 STOCKTON, CA 95205 COUNTY # 3 7 <br /> �[ PHONE NO. 468-3423 I <br /> �JfJ,�,, INSPECTION DATE: ,? <br /> SITE NAME: C�GLli ka, SCG[G� Z4 G , <br /> SITE ADDRESS: /� Q !,(J r v . 1'G Ly <br /> CITYISTATE/ZIP C �/j�' 557 j <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK' Q a— TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER#} PER#.; PER # <br /> l LCA EXP DATE EXP DATE i EXP DATE EXP DATE i <br /> OPERATIONAL TANK TANK CONTENTS a F <br /> MAJOR MINOR <br /> I <br /> PERMIT TO OPERATE 1 2 -- <br /> CHANGE IN CONDITIONS TO OPERATE 3 q <br /> APPROVED CONSTRUCTION S 6 ____,__�_-_•___ _- _____ _ . . -- I <br /> WRITTEN MONITORING PROCEDURES 7 e. <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 !i - <br /> TANK GAUGING 23 24 -- <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 �� _ - - - - s ❑� µ� ��, - � T �� — <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 l3r, <br /> CONDITIONS ABATED 37 <br /> !I <br /> , b� <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 /> IF { <br /> PERMANENT TANK CLOSURES <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 ANO MUST BE GOR TED AS <br /> SYSTEM STATUS(MUST MARK ONEIr <br /> FOLLOWS: - <br /> 57 58 59 <br /> MAJOR MINOR <br /> ❑ VI . OL. IOL.❑ <br /> OFFICE: WSP: OrRECEIVED BY: <br /> TITLE: P ONE: BECK: <br /> G�� S <br /> H=IT—q O GINAL <br /> r. !_ <br />