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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br />WAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME:INSPECTION DATE: <br />f fG17 3 vi9/ Q /� 2— <br />SITE ADDRESS: Z 3S S. Syb� Flo CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER Z <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER 3 <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TYOF INSPECTION <br />©V ✓lp <br />SITE COMPUTER # <br />/ y f Z <br />b <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CCNTEN s <br />R !� <br />40 <br />.. <br />41 142- <br />MAJOR MINOR <br />1 2 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />3 4 <br />5 6 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />;YSTEM STAATTUUSS (MUST MARK ONE) <br />7 8 <br />FOLLOWS: <br />9 10 <br />59 <br />LJ NU <br />❑ <br />11 12 <br />- <br />_ <br />13 14 <br />15 16 <br />-, <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />- <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />38 39 <br />_.—. <br />48 <br />49 LL-- <br />FLAMMABLE VAPORS REMOVED <br />40 <br />.. <br />41 142- <br />- <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 - <br />PIPING <br />48 <br />49 LL-- <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />;YSTEM STAATTUUSS (MUST MARK ONE) <br />FOLLOWS: <br />7 58 <br />SMAJOR <br />59 <br />LJ NU <br />❑ <br />VIOL. LI VIOL.R VIOL <br />HUT -3 <br />TITLE: <br />ORIGINAL <br />PECK: <br />5/88 0, <br />