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COUNTY NAME <br />I imam <br />UNDERGROUw TANK PROGRAM OFFICIAL INSTIONREPORT 2 - <br />SAN JOAQUIN HEALTH DIS IC <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 COUNTY # <br />'SITE NAME: F; E CM 0, N— •, <br />v <br />SITE ADDRESS: CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />fps, w <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE OF INSPECTION <br />ISITE COMPUTER # <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD 135 <br />CONDITIONS ABATED <br />TANK CONTENTS <br />MAJOR MINOR <br />1 <br />q, <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />.36 <br />37 <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />'OWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />3EMOVAL OF RESIDUAL MATERIALS <br />DIPING <br />-LAMMABLE VAPORS REMOVED <br />JNAUTHORIZED RELEASE <br />3AMPLING <br />MPROPER ABANDONMENT <br />�Im <br />=Nll <br />=13 <br />ME <br />�fm <br />46 47 <br />48 49 <br />50 m <br />51 52 <br />53 54 <br />55 56 <br />fSTEM STATUS (MUST MARK ONE) <br />58 <br />MAJOR 57 Eg MINOR VIOL-❑ <br />NO 59 <br />H VIOL H <br />OFFICE: INSP: <br />TITLE: <br />HUT -3 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />RECEIVED Y: <br />PHONE <br />" RECK <br />K <br />