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UNDERGROUN <br />K <br />PROGRAM OFFICIAL INSP <br />N REPORT <br />JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />; <br />2� <br />INSPECTION DATE: <br />a �,c <br />O <br />SITE ADDRESS: Cl -r2— <br />VSC <br />�` CITY/STATE/ZIP <br />r✓t <br />a C 9 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK 0 t TANK OZ- <br />TANK O 3 <br />TANK ©� <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # PER # <br />PER # <br />PER # <br />V 111 I L/ 24 <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTSis <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />y <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />7 <br />9 <br />8 <br />10 <br />MONITORING SYSTEM <br />11 <br />12�- <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />}( <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />_ <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />ry <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />q45 <br />ACCESS LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />MIN MIN i <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />�� <br />µ <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />155 <br />156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />S'ec <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ <br />❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: INS_ � RECEIVED BY: <br />G3-G <br />)4pz�/Z// <br />Gil <br />TITLE: s PHONE: BECK: <br />HUT -3 ORIGINAL 5/88 0' <br />