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UNDERGROUN�VK <br />TEMPORARY TANK CLOSURE <br />PROGRAM OFFICIAL INSPE <br />N REPORT <br />REMOVAL OF RESIDUAL <br />V JOAQUIN HEALTH DISTRICT <br />38 <br />j39 <br />1601 E. HAZELTON AVE. <br />FLAMMABLE VAPORS REMOVED <br />COUNTY NAME <br />40 <br />STOCKTON, CA 95205 <br />COUNTY # <br />ACCESS LOCATIONS SEALED <br />41 <br />PHONE NO. 468-3423 <br />SITE NAME: <br />/ . <br />3 <br />INSPECTION DATE: 5_ <br />�a <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />SITE ADDRESS: ,Z <br />�� CITY/STATE/ZIP <br />1UI4,f lec <br />d 7 <br />Q � <br />', <br />f <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK L9 TANK lCD <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />PIPING <br />COMPUTER COMPUTER <br />COMPUTER <br />COMPUTER <br />FLAMMABLE VAPORS REMOVED <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # PER # <br />PER # <br />PER # <br />L 6 <br />52 <br />rl l <br />2 <br />53 <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />IMPROPER ABANDONMENT <br />TANK CONTENTS <br />55 <br />56 <br />MAJOR MINOR <br />THE MAR <br />PERMIT TO OPERATE <br />1 <br />2 <br />�( <br />FOLLOWS: <br />CHANGE IN CONDITIONS TO OPERATE <br />57 58 <br />3 <br />4 <br />L <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />OFFICE: <br />INSP: � <br />13 <br />14� <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />dl <br />PHONE: Adak <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 />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />31 <br />32 <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />//, <br />37 <br />HUT -3 Now ORIGINAL 5/88 0 <br />TEMPORARY TANK CLOSURE <br />M, <br />REMOVAL OF RESIDUAL <br />38 <br />j39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />M43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSUREmom= <br />NO <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />µ M <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MAR <br />ED ITEMS REPRES NT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />L <br />MAJOR MINOR <br />❑ <br />NO <br />VIOL. ❑ <br />VIOL. VIOL. <br />OFFICE: <br />INSP: � <br />RECEIVED BY - <br />TITLE: <br />dl <br />PHONE: Adak <br />RECK: <br />HUT -3 Now ORIGINAL 5/88 0 <br />