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UNDERGROUJW TANK PROGRAM OFFICIAL INSP "TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC F <br /> 1601 E. HAZELTON AVE. q <br /> COUNTY NAME STOCKTNO. CA COUNTY # <br /> PHONE NO. 468-3423-3423 <br /> SITE NAME: X I J INSPECTION DATE: 3 l 9 l <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK b' TANK ®�'� TANK �� TANK <br /> FORM A AND/OR B SUBMITTED? @�' COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTIO SIT COMPUTER# <br /> PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE I EXP.DATE I 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 18 <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 s <br /> APPROVED RESPONSE PLAN 25 26 - <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 w. � ��� � �••�� <br /> APPROVED TANK REPAIRS 31 32 —� <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 a <br /> CONDITIONS ABATED 37 � ��� � _ � � • <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 q45 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED <br /> OWNER/OP MONITORING 44 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL SIDUAL MATERIALS 46 47 <br /> .., v. <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 � <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 _,..w� ...•,, .�, _._..�_ <br /> IMPROPER ABANDONMENT 55 156 <br /> THE MARKED ITEMS REPR SE T VIOL�IONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 1�" <br /> 57 58 5 <br /> MAJORMINOR NO <br /> VIOL. LiVIOL. LiVIOL. <br /> OFFICE: INSP: �40RECEIVED BY: <br /> TITLE: ul PHONE: BECK: <br /> HUT-3 ORIGINAL 5/88 0° <br />