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UNDERGROU' STANK PROGRAM OFFICIAL INSF'AN JOAQUIN HEALTH D STRICIy TION REPORT 1601 E. HAZELTON AVE. a STOCKTON, CA 95205 COUNTY # 9 COUNTY NAME. PHONE NO. 468-3423 SITE NAME: G, INSPECTION DATE: 41/alG/gy SITE ADDRESS 3 r CITY/STATE/ZIP s'T�� /} 7 Jrz;7lo"5 CHANGES SITE/OWNER/PERMIT? YES NO TANK, O Y TANK (p,;ITANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER L, NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# �✓a PER# PER# 9 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK AJ R MINOR IN R MAJOR MINOfl 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 15 16 ACCESS CASING SECURED 1718 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 126 1 _ UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 - APPROVED TANK REPAIRS 31 32 ;UNAUSAFETY HAZARD THORIZED RELEASES REPORTED 33 34 _ SAFETY HAZARD 35 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL I38 39 FLAMMABLE VAPORS REMOVED W4445 ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 �\ FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT V10 ATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: T&4ik a _ 57 MINO58NO 59 ' VIOLOR ❑ VIOLR ❑ VIOL❑ OFFICE: INS P: ` _,/./. _ _ RECEIVED BY: ''J TITLE: K " PHONE: BECK: HUT-3 ORIGINAL