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UNDERGROUNDIK PROGRAM OFFICIAL INSPEC N REPORT <br />I JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY # :?4' <br />PHONE NO. 468-3423 <br />SITE NAME: ?A44, ? <br />INSPECTION DATE: g 2 <br />SITE ADDRESS: <br />-{ CITY/STATE/ZIPi <br />1 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK TANK <br />TANK ` TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTE COMPUTER <br />-� <br />COMPUTER COMPUTER <br />NUMBE n �Q� NUMBER <br />NUMBER NUMBER <br />TYP OF INSPECTION SITE COMP/TJER # <br />L��i <br />PER # ` o� PER # <br />'�1 <br />PER # PER # <br />�'✓L�/ <br />EXP. DATE EXP. DATE <br />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 />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 />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 />_ <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />µ� <br />SAFETY HAZARD <br />35 <br />36 <br />m <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />_ ._._.�._ _._.� %x�✓M <br />...��.___ ri _..�,�� <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 />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />_ <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />- <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />THE MARKED IT S REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:" <br />57 58 59 <br />/' <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP1,7/ <br />A-eAa _ _ <br />RECEIVED BY: <br />TITLE: %� �� <br />HUT -3 / ORIGINAL <br />Ld <br />BECK: <br />5/88 O M <br />