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�• , UNDERGROUND NK PROGRAM OFFICIAL INSPE ,RFPn�,a -7-10 / <br /> "nk IM JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: S 4e '2 o- D INSPECTION DATE: Y-1 <br /> SITE ADDRESS: (,t� CITY/STATE/ZIP - 16 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK +��J TANK Z.� TANK 2. TANK - - <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUT �$(� <br /> TYPE OF INS CTION SITE COMPUTER# NUMBER °° NUMBER !�(l NUMBER NUMBER (� <br /> PER# PER# (J PER# PER# �1 <br /> Al <br /> J EXP.DATE 1 EXP.DATE i�/t EXP.DATE 1 EXP.DATE <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 <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 3536 � <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE. <br /> REMOVAL OF RESIDUAL 38 39 w _, <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ` <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 --- <br /> FLAMMABLE VAPORS REMOVED 50 � � u _" <br /> UNAUTHORIZED RELEASE 51 52 M <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: <br /> MAJOR 57 iul MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> Jj <br /> OFFICE: INSP: •� �� RECEIV D BY: <br /> TITL�J PHONE: BECK: <br /> HUT-3 ORIGINAL <br />