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TANK PROGRAM OFFICIAL UNDERGROUI'SAN JOAQUIN HEALTH DISTRICT F- 1601 E. HAZELTON AVE. STOCKTON, CA 95205 423 TION REPORT COUNTY # 3 7 4UU1111 NIWIL c1b O h PHONE NO. 468-3 INSPECTION DATE:AD l/ SITE NAME: � e ADDRESS: CITY/STATE/ZIP SITE )--'Jf! /'(f CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK TANK TANK COMPUTER AAND/OR B SUBMITTED? OMPUTER COMPUTER COMPUTER NUMBER NUMBER FORM UMBER NUMBER TYPE OF INSPECTION SITE UTE ## R # PER # PER # PER # ^COMP.R 5 E P. DATE EXP. DATE EXP. DATE EXP. DATE OPERATIONAL TANK TANK CONTENTS 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 13 14 _ _ -- MONITORING RECORDS MAINTAINED 15 ACCESS CASING SECURED 17 16 18 G 1 _ - - 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 353_6 CONDITIONS ABATED 7 37_M[ TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL VAPORS REMOVED ACCESS LOCATIONS SEALED R3839FLAMMABLE POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPUNG 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS (MusT MARK ONE) FOLLOWS: 57 58 59MAJ 9 INO OR LJVIOLOR ❑ ❑ VIOLVIOL OFFICE: INSP: V j RECEIVED BY: TIT E: PHONE: BECK: HUT -3 OR16INAL 5/88 U