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UNDERGROUN NK PROGRAM OFFICIAL INSP ON REPORT <br />JKN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY # } <br />MAJOR MINOR <br />SITE NAME: <br />1'k11 4- sl�4 <br />6-"'j <br />NSPECTION DATED <br />CHANGE IN CONDITIONS TO OPERATE 3 4 <br />fl a--1 <br />APPROVED CONSTRUCTION 5 6 �u <br />SITE ADDRESS:�j'J,I� <br />c�fj-/�iSQ/',� <br />/ <br />CITY/STATE/ZIP <br />APPROVED MONITORING SYSTEM 9 10 <br />MONITORING SYSTEM 11 12 <br />APPROVED MONITOR FREQUENCY 13 14 <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO TANR <br />COMPUTER <br />TANK <br />COMPUTER <br />TANK <br />COMPUTERS <br />TANK <br />COMPUTER <br />FORM A AND/OR B SUBMITTED? <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 24 <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE CO/M' PUUJTER # PER # <br />/ / �, EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />OFFICE: <br />INSP: &/'' , <br />TITLE: QS PHONE: <br />HUT -3 /l ORIGINAL <br />RECK: <br />5/88 0 M <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 �u <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 38 39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED 43 <br />OWNER/OPERATOR MONITORING 44 <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 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: 2- <br />57 58 59 <br />MAJORjg[ MINOR NO <br />VIOL. VIOL. ❑ VIOL. ❑ _ ./,.,,._ ]L/t�i{ �\ <br />OFFICE: <br />INSP: &/'' , <br />TITLE: QS PHONE: <br />HUT -3 /l ORIGINAL <br />RECK: <br />5/88 0 M <br />