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UNDERGROUND T4NK PROGRAM OFFICIAL INSPEC-'ON REPORT ,N JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. STOCKTON, CA 95205 COUNTY # 3 ', COUNTY NAME PHONE NO. 468-3423 SITE NAME: FyV BSTµ} s(, C l,�exiv-o rJ INSPECTION DATE: y-3�gZ SITE ADDRESS: CITY/STATE/ZIP �A 6A, if �3 CHANGES SITE YES NO TANK TANK v TANK 3 TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTERA COMPUTER NUMBER v L NUMBER P J VS V) NUMBER //L7 D NUMBER TYPE OF INSPECTION SITE COMPUTER# PERIP 10J00(] PER# ZJ PER# !� PER# 2j U (l EXP.DATE EXP.D E EXP.DATE EXP.DATE OPERATIONAL TANK WI � MAJOR MINOR ' PERMIT TO OPERATE 1 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 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 -- TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 __ - UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 -- - - APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 - SAFETY HAZARD CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE Eli REMOVAL OF RESIDUAL W43 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 _ PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 --- UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 --- IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: BMINOR NO 57 58 59 VIOLOR ❑ VIOL ❑ VIOL IN OFFICE: INS P:/,Vx REC I D BY: WILE: _ da RECK: f�df o33� ¢ n HUT-3 ORIGINAL