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UNDERGROUNI%NK PROGRAM OFFICIAL INSPE(A" unN REPORT <br /> N JOAQUIN HEALTH DISTRICT " <br /> QJ 1601 E. HAZELTON AVE. <br /> COUNTY NAME (� STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: a �,� �� �/� INSPECTION DATE: /0/--, <br /> y g� <br /> SITE ADDRESS: a /_ (a 1;11 /)/� /` J CITY/STATE/ZIP S f C,4 <br /> CHANGES SITE/OWNEtIR�/PERMIT? /AYES NO TANK d l TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF I ECTION SITE COMPUTER# NUMBER/3 Q(p NUMBER 13P NUMBER NUMBER <br /> D © 134M <br /> PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNrENrs <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 [35 <br /> 24 T <br /> APPROVED RESPONSE PLAN 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 ^ <br /> UNAUTHORIZED RELEASES REPORTED 34 ^ <br /> SAFETY HAZARD 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 n <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 <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) F LLOWS: <br /> MAJOR 57 MINOR NO 4 <br /> VIOL. VIOL VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: .�C��.,�U PHONE: BECK: <br /> HUT-3 ORIGINAL sisa O� <br />