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r <br /> UNDERGROUN ANK PROGRAM OFFICIAL INSP '''ION REPORT <br /> AN JOAOUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. ' <br /> STOCKTON, CA 95205 COUNTY # 3 <br /> ` COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: .17 `- INSPECTION DATE. ✓�/� <br /> +�f. <br /> �s CITY/STATE/ZIPs7f.'� <br /> SITE ADDRESS: S',� �j L/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO T NK TANK TANK TANK <br /> COMPUTER COMPUTER COMPUTER COMPUTER <br /> FORM RAND/OR B SUBMITTED? NUMBERl d00 L NUMBERNUMBER NUMBER <br /> TYPE OF INSPECTIONl!�� SITE COMPUTER# PER# ,/ (L7 PER# PER PER# <br /> EXP.dA V <br /> iQ'Y140l� S ' / + EXP.DATE EXP DATE <br /> lam" EXP-DATE <br /> TAy :b <br /> f OPERATIONAL TANK f <br /> NK CONiElV75 �" .. ,�. <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 1,35 36 <br /> CONDITIONS ABATED . 37 <br /> TEMPORARY TANK CLOSUREyw - 4 , <br /> � ,��-, <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 44 45 <br /> PERMANENT TANK CLOSURE <br /> W <br /> �� <br /> I REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49. <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) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL_ ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP:` RECEIVED BY: <br /> TITLE:/`- PHONE: BECK: <br /> i <br />