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UNDERGROUND KIK PROGRAM OFFICIAL INSPECN REPORT <br /> I JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: lel lINSPECTION DATE/, <br /> /[ s �>? <br /> SITE ADDRESS: - �" � CITY/STATE/ZIP_57. <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK 31TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER. COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER`�� L? <br /> � NUMBE� l NUMBER t� Y NUMBER <br /> �! PER# '�� ++ PER# /J PER#ems„ VIZ, PER# <br /> EXP.DA �L EXP.DA u 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 <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 35 36 _,._ ,_. _.•. <br /> CONDITIONS ABATED 7377W <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 7 _..,,. <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 -_____..�.---�-µ- -•----�- ---•.._,,�...�.. <br /> SAMPLING 153 154 <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MD ITEMS REPRESENT O�LiATION AND MUST BSE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOQGS: L✓�� ZJ 4'-w <br /> A <br /> 57 58 59 <br /> MAJOR NO <br /> VIOL. ❑ VIOLL..R ❑ VOL.® <br /> S O. L / D l�J �/ S i•� 114Z, <br /> F — <br /> OFFICE: INSP: RECEIVED BYV/ /iv <br /> ;4--- <br /> TiTLEf7b- `'��03 PH NE: BECK: <br /> HUT-3 / ORIGINAL 5/88 0 M <br />