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r � <br /> UNDERGROUNJfAN <br /> NK PROGRAM OFFICIAL INSP ON REPOT / b r3 <br /> ` JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> [SITE NAME: INSPECTION DATEZ? Z3_, <br /> SITE ADDRESS: A2 � C i �v TY/STATE/ 3 7 <br /> CHANGES SITE/OWNER/PERMIT? YES J NO TANK TANK 2� TANK i1 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER _ COMPUTER �( COMPUT R <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER/100044 NUMBED/�G j NUMBER W N 01 NUMBE <br /> PER# l u PER#i�/D 0 V PER#�6 PER#/ j <br /> EXP:DATE EXP.t) EXP.DATE I 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 mw <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 v <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 w <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 3181639 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 42 �..n, ___�___ """" '"""'"' `�" ----•--•------..,,....w <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 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 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 7 58 59 ^ <br /> MAJOR MINOR NO <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP RECEIVED BY: <br /> . TITLE: C�\�%�� PHONE: BECK: <br /> :AUT-3 ORIGINAL 5/88 0m <br />