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UNDERGROUNNK PROGRAM OFFICIAL INSPE#ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />c , <br />INSPECTION DATE: <br />SITE ADDRESS: ' <br />Z4-1- <br />CITY/STATE/ZIP 9737- j <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />SITE COMPUTER <br /># <br />NUMBE7'7 t%0 <br />/ <br />NUMBER NUMBER NUMBER <br />TY,g OF INSN <br />PER # <br />PER # PER # PER # <br />Ao1r 3 <br />°(S <br />, <br />/ <br />EXP. DATA <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />.. <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />H <br />APPROVED MONITORING SYSTEM <br />9 <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 />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 />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />136 <br />CONDITIONS ABATED <br />r37 <br />TEMPORARY TANK CLOSURE <br />vim <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45� <br />PERMANENT TANK CLOSURE <br />NO <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />- <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />��� �� � __. �_���, _ � �✓� <br />IMPROPER ABANDONMENT <br />155 <br />156 <br />THE MARKED ITEM, REPRESENT VIOLATIONS AND MUST BE <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: 57 58 59 f <br />MAJORMINOR NO IL] <br />VIOL. VIOL. VIOL. <br />OFFICE <br />TITLE: S / 0 <br />m <br />BECK: <br />AS <br />IHUT -3 ORIGINAL 5/88 ©M <br />