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UNDERGROUt TANK PROGRAM OFFICIAL INSPF 'TION REPORT USAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME��n STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 p SITE NAME: W "�aw ak d� INSPECTION DATE: SITE ADDRESS: 1s /- J f-nj CITY/STATE/ZIP �� C/7Q CHANGES SITE/OWNER/PERMIT? WES NO TANK / TANK ;I— TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# re- / 5 PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANdl TANK CON Nn 1G cYfc MAJOfl MINOR ..: I,ZM 12 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 19 120 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 wt7 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE 2 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: pa fe, 57 58 59 MINOR NO VIOLOR ❑ VIOL ❑ VIOL.❑ OFFICE: INS .Ic RECEIVED BY: LIT V U LG TITLE: PHONE: RECK: HUT-3 ORIGINAL seas O