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TANK UNDERGROW- SAN PROD N HEALTH D STRICTRAM OFFICIAL SP- TION REPORT 1601 E. HAZELTON AVE. COUNTY #`� STOCKTON, CA 95205 COUNTY NAME I, PHONE NO. 468-3423 INSPECTION DATE: SITE NAME: S 6 , �(a� CITY/STATE/ZIP SITE ADDRESS: -T-/ 00 TANK TANK TANK ANK CHANGES SITE YES NO TANK COMPUTER FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER PER# PER # PER# TYPE OF INSPECTION SITE COMER j' PER# EXP DATE �) �j}'/ EXP.DATE EXP.DATE EXP.DATE TANK CONTENTS i F` _ OPERATIONAL TANK MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 8 APPROVED CONSTRUCTION 5 - WRITTEN MONITORING PROCEDURES 7 8 _. -.. _. .-. _. .-.. _-. ...- APPROVED MONITORING SYSTEM 9 10 --- --- _ "--- MONITORING SYSTEM 11 12 - --- - --- _- -"- ----- APPROVED MONITOR FREQUENCY 13 14 -. - - ----- MONITORING RECORDS MAINTAINED 15 1 ------------------------ 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 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 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 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) FOL CWS: ✓�•f 57 58 MAJOR MINOR ❑ NO 5 VIOL VIOL. VIOL. OFFICE: INSP: �j, - RECEIVED BY: TITLE: �, PHONE: RECK: �n HUT-3 ORIGINAL alae C