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UNDERGROUNDJ&NK PROGRAM OFFICIAL INSPECWN REPORT <br /> N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 22 <br /> SITE NAME: '/ INSPECTION DATE: <br /> SITE ADDRESS: CITY/STAT 4 T.3 1 <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK TANK TA ANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER coMPUT ! COMPUTER COMPUTER <br /> TYP OF INSPECTION SITE COMPUTER# NUMBY;1 L , NUMBER NUMBER-"� UMBFsR, _c00 <br /> PER# PER#�r PER# 11 v PER#1 �U <br /> 17o EXP.DATE U EXP.DATE �/ EXP.DATE /�u EXP.DATE D <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 µ <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 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 3839 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 424 <br /> _ <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 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> g?de4A -7 <br /> MAJOR 57 MINOR 58 NO 59 <br /> mr <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: - INSP: RECEIVED BY: <br /> Q.&iwl� <br /> �„�^/� � � TITLE: If�— PHONE: BECK: <br /> u,6 I <br /> HUT-3 ice/ ORIGINAL 5188 0" <br />