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{' UNDERGRC W") --NK PROGRAM OFFICIAL I �PFCTION REPORT .jq JOAQ IIN HEALT1601 E. HAZELTON H DIS STOCKTON, CA 95205 COUNTY COUNTY �A � l , PHONE NO. 468-3423 INSPECTION DATE: L, ITE NAME: P d CITY/STATE/ZIP ITE ADDRESS: TANK C)�„ TANK41 TANK ? YES NO TANK 01 COMPUTER COMPUTER tFjANGES SITEtOWNERIPERMIT COMPUTER COMPUTER NUMBER NUMBER ORM A AND/OR B SUBMITTED? NUMBER NUMBER PER PER PER # # # SITE COMPUTER # PER# EXP.DATE EXP.DATE r YPE OF INSPECTION j EXP.DATE c.It EXP.DATE TANK CONTENTS OPERATIONAL TANK MAJOR MINOR 1 2 PERMIT TO OPERATE 3 4 uHANGE IN CONDITIONS TO OPERATE 6 6 APPROVED CONSTRUCTION 7 8 WRITTEN MONITORING PROCEDURE APPROVED MONITORING SYSTEM 9 10 ' 11 12 MONITORING SYSTEM { 13 14 1 i�PPROVED MONITOR FREQUENCY MONITORING RECORDS MAINTAINED 15 16 17 18 _ ACCESS CASING SECURED 19 20 PIPING 21 22 — 1VENTORY RECONCILIATION 23 24 ' "ANK GAUGING 25 26 APPROVED RESPONSE PLAN 28 UNAUTHORIZED RELEASE OCCURRENCE 29 30 SAMPLING 31 32 I APPROVED TANK REPAIRS 33 34 I UNAUTHORIZED RELEASES REPORTED 36 36 SAFETY HAZARD 37 / CONDITIONS ABATED a TEMPORARY TANK CLOSURE 38 39 REMOVAL OF RESIDUAL 40 FLAMMABLE VAPORS REMOVED 41 42 ACCESS LOCATIONS SEALED 43 POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 46 i PERMANENT TANK CLOSURE 4g 47 REMOVAL OF RESIDUAL MATERIALS 49 PIPING 50 FLAMMABLE VAPORS REMOVED 51 52 UNAUTHORIZED RELEASE 53 54 SAMPLING 55 56 I(vIPROPER ABANDONMENT THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS{MUST MARK ONE) FOLLOWS: 59 57 57 MINOR [ }58 N(1:1 — MAJOR F� VIOL. I_ -- —�� -- VIOL. RECEIVED BY: OFFICE: INSP: C =`� PHONE: RECK: TITLE: , �rs4 �Ri1�4 L