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UNDERGROUN— TANK PROGRAM OFFICIAL INSPF TION REPORT <br />-_jAN JOAQUIN HEALTH DISTRICT — <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 gQpffry # <br />PHONE NO. 468-3423 <br />SITE NAME: /�D�� U 7� G� E <br />I <br />INSPECTION DATE: <br />SITE ADDRESS: p0 S � D� <br />CITY/STATE/ZIP��.. <br />9�oZ 0/0 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK <br />p TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # PER # <br />4 <br />PER # <br />PER # <br />PER # <br />O EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TANKCOWENTs <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 3 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 24 <br />_ <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 />_ <br />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 39 <br />FLAMMABLE VAPORS REMOVED 40 <br />- <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED 43 <br />_ <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 />_ <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />F� /'ES`� `%uO <br />57 <br />MAJOR MINOR ❑� NO E] <br />VIOL. VIOL. VIOL <br />OFFICE:INSPPG <br />RECEIVED BY: <br />TITLE: E_ �9 S <br />PHONE: <br />D�i3 <br />QK <br />. <br />N6S <br />HUT -3 ORIGINAL sees OM <br />