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UNDERGROUND' TANK PROGRAM OFFICIAL INSPEf--90N REPORT SAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. Q COUNTY NAME STOCKTON, CA 95205 COUNTY # 3/ PHONE NO. 468-3423 SITE NAME: G r,47 70AJ INSPECTION DATE: SITE ADDRESS: S7 CITY/STATE/ZIP F CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER fo a oNUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER S#J PER# wp.5;g PER # PER # PER# 2 D / EXP.DATE e`L EXP DATE EXP.DATE EXP.DATE TANK CONTENTS---F- OPERATIONAL ONTENTS OPERATIONAL TANK 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 k25 14 _ MONITORING RECORDS MAINTAINED 16 _ ACCESS CASING SECURED 18 PIPING 20 INVENTORY RECONCILIATION 22 TANK GAUGING 24 APPROVED RESPONSE PLAN 26 UNAUTHORIZED RELEASE OCCURRENCE 27 128 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 4142 POWER DISCONNECTED Ma 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 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57MINOR 58 59 NO VIOL ❑ VIOL. ❑ VIOL. OFFICE: INSP:lN� RECEIVED BY: TITLE: PHONE: BECK: HUT-3 ORIGINAL 51W