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i <br /> UNDERGROI"' ANK PROGRAM OFFICIAL INSP�r, )N REPORT <br /> 3AN JOAOUIN HEALTH DISTRICo <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423,. <br /> SITE NAME: ��/P ��., INSPECTION DATE: <br /> SITE ADDRESS: 7 CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER PER <br /> EXP.DATE 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 --W -- -- - -- <br /> MONITORING SYSTEM 11 12 _ - ._ - -. •__ <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 �' f <br /> ACCESS CASING SECURED 17 18 - ��L�/gyp <br /> PIPING 19 20 etA ' I"v _-_-- <br /> INVENTORY RECONCILIATION 21 22 C <br /> TANK GAUGING 23 24 . <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTI-ORIZED RELEASE OCCURRENCE 27 28 - <br /> SAMPLING 29 30 <br /> } APPROVED TANK REPAIRS 31 32 �- — - - <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <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 i <br /> POWER'DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE � � <br /> REMOVAL O I UAL MATERIALS 46 147 <br /> PIPING 48 49 _w. <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 — <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) <br /> FOLLOWS-_-=,-? 6'� _ <br /> ss ` ccu acicn <br /> MAJOR 57 MINOR 58 NVIOO 59 S �r/i r.,j_ �r F v� cy� :s 1� v7r �` HG�KtA- <br /> VIOL ❑ VIOL- LiL „r ,7,k , <br /> M <br /> OFFICE: INSP: 04kol c Z, RECEIVED BY: , <br /> TITLE: �,�� PHONE: BECK: <br /> HUT-3 ORIGINAL s se 0 <br />