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UNDERGROUNf TANK PROGRAM OFFICIAL INSPEr-'ON REPORT ..AN JOAQUIN HEALTH DISTRICT _ 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # 31 PHONE NO. 468-3423 SITE NAME: ^O ,f S? d,� '��•?,rl�^/{�L INSPECTION DATE: ll- �1 SITE ADDRESS: *W r *�LIOn/ CITY/STATE/ZIP �N 5W- O3 CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK Z TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK UNKCONIENTS MAJOR I 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 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 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 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 UNAUTHORIZED RELEASE 51 52 _ SAMPLING 53 54 _ IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AN,p MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: gr ^- MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL ❑ VIOL (ivt Of OFFICE: INSP:1e/ RECEIVED BY: O�- TITLE:A�s PHONE: CK: HUT-3 ORIGINAL 5/w O