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UNDERGROU►� TANK PROGRAM OFFICIAL INSP'TION REPORT USAN JOAQUIN HEALTH DISTRICT)w J O 1601 E. HAZELTON AVE. COUNTY NAME 5 STOCKTON, CA 95205 COUNTY # 3 PHONE NO. 468-3423 SITE NAME: /{ 1 xP or-/- INSPECTION DATE: SITE ADDRESS: f,D ^/ �f!tR* Ad, CITY/STATE/ZIP c5hwm 6fQ CHANGES SITE/OWNER/PERMIT'? AYES NO TANK Dy TANK D TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER 3 COMPUTER COMPUTER NUMBER ER NUMBER NUMBER SPECTION SIT COMPUTER## PER# PER pY �✓ EXP.DATE U�G EXP.DATE EXP.DATE XP.DATE KC OPERATIONAL TANK MAJOR MITAOR I' ENIS NOR - PERMIT TO OPERATE 1 Vf 2 CHANGE IN CONDITIONS TO OPERATE 3 4 _ APPROVED CONSTRUCTION 5 6 _ / _•�-- __ WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 _ APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 _ ACCESS CASING SECURED 17 18 _ PIPING 19 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 ,_ �I V, UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 _. APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 134 SAFETY HAZARD 35 36 - CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 3B 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 _ OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 l IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 58 i9 MAJOR57 MINOR NO VIOL VIOL LJ VIOL. OFFICE: INSP: / 1RErElx&D TITLE: S/� PON BECK HLIT-3 �/I' ORIGINAL