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UNDERGROUN NNK PROGRAM OFFICIAL INSPE ON REPORT <br /> JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY #` <br /> PHONE NO. 468-3423 <br /> SITE NAME: 1 �f C� b INSPECTION DATE: <br /> SITE ADDRESS: •- LD �� e CIT <br /> Y/STATEIZIP � 7� <br /> zJ r <br /> CHANGES SITE R/PERMIT? YES NO TANK TANK ''j/ TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER n COMPUTER COMPUTER <br /> TYPE OF I SPECTION SITE COMPUTER# NUMBER„ 50 NUMBER NUMBER NUMBER <br /> �( ],, [, ��L PER# lj /�.' PER# r��� � PER# PER# <br /> ``Yi lZe,,�,b V / I L � EXP.DATE i1* EXP.DATE EXP.DATE 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 �m <br /> MONITORING RECORDS MAINTAINED 15 16 µ T <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 _m <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 W <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 144 145 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING48 49 .— .m.„...Y._.. W.�__...._._..... __.._.._.. ..._. .__.-.._ <br /> FLAMMABLE VAPORS REMOVED 50 e w G <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 156 <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 /> Ul <br /> VIOL. ❑ VIOL. ❑ VIOL.JeN <br /> Af <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: ��;�f PHONE: BECK: <br /> HUT-3 �J(J ORIGINAL 5/88 O M <br />