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UNDERGROUND NK PROGRAM OFFICIAL INSPE N REPORT (� <br /> WN ./ <br /> JOAQUIN HEALTH DISTRICT � �✓-�' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: `► G� �p �� INSPECTION DATE: <br /> SITE ADDRESS: 6,6 ` •, LL O: 7 CITY/STATE/ZIP 4 ' 3 7� <br /> CHANGES SITE/OWNER/PERMIT? YES f No TANK ij'�� TANK �c�2� TANK r TANK �. <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUT ,.�� COMPUTER �. COMPUT <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBE �(JU; NUMBER 'o NUMBE62, <br /> �A �✓ PER# „a1,f PER# (,, PER# � � PER# w^`� <br /> 4� ,.� EXP.DATE G'��'►► EXP.DATE � EXP.DATE 1 EXP.DATE r), <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 [27 <br /> 10 <br /> MONITORING SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 V 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE 10 <br /> REMOVAL OF RESIDUAL 38 t42 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS r5l <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 52SAMPLING 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 MINOR 58 NO 59 <br /> VIOL. VIOL. 0 VIOL.❑ <br /> OFFICE: INSPS��' RECEIV BY \ <br /> x 6N )( <br /> TITLEI Ve PHONE: BECK: <br /> alae <br /> HUIN <br /> T-3 - - - ORIGAL <br />