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UNDERGROUND NK PROGRAM OFFICIAL INSPEC')N REPORT 0 r L N JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY # 7j STOCKTON, CA 95205 COUNTY NAME PHONE NO. 468-3423 / SITE NAME: �/e,v�.,�4.. � C�p�✓R,or� INSPECTION DATE:Z f Ip �LIJ SITE ADDRESS: /03 S7 CITY/STATE/ZIP7 -76 TANK ^ TANK TANK COMPUTER CHANGES SITE/OWNER/PERMIT? YES NO TANK Iu/ COMPUTER ` COMPUTEFF�� COMPUTER FORM A AND/OR B SUBMITTED? NUMBER /�jQCN+ NUMBER W NUMBED aD,�TYPE OF INSPECTION SITE COMPUTER# PER# PER#/�O PER✓O)ODO PER# SSV O NG l/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK CONTENTS OPERATIONAL TANK MAJOR MINON PERMIT TO OPERATE 1 2 - CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 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 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 REMOVAL OF RESIDUAL W444 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 _ ME- 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: lf Af MAJOR 57 MINOR 58 NO 59 VIOL VIOL ❑ VIOL❑ Le Ll OFFICE: INSP: 4,XRE EIVED BY: TITLE: AZA NE: RECI : HUT-3 ORIGINAL sine 0M