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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT WSAN JOAQUIN HEALTH DISTRICTT 1601 E. HAZELTON AVE. COUNTY NAME Sce.-�j STOCKTON, CA 95205 COUNTY PHONE NO. 468-3423 #3 SITE NAME: S, C' S /leo F _ 1�a�^C INSPECTION DATE:o,a 7-/I SITE ADDRESS: �a If-70 �-(JG RetCITY/STATE/ZIPjG/��j� �'� I Jo�3' CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 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 MAIM ENTS MINOR MAJOR OR NOR 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 21 122 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 W43 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 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 _ SAMPLING 53 54 / IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: d ----- 59 MAJOR MINOR 57 NO VIOL. VIOL. VIOL. OFFICE: INSP RECEIVED BY: TITLE: PHONE: BECK: HUT-3 ORIGINAL siaa O,