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UNDERGROOP TANK PROGRAM OFFICIAL IN CTION REPORT SAN JOAQUIN HEALTH DISTRI� 1601 E. HAZELTON AVE. STOCKTON, CA COUNTY NAME PHONE NO. 4 8934203 COUNTY # SITE NAME: INSPECTION DATE: SITE ADDRESS: ra/) A CITY/STATE/ZIPG�� ''71�r� CHANGES SITE/OWNER/PERMIT? YES NO TANK o TANK TANK TANK FORM AAND/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 rANKcowreN R 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 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 - SAMPUNG 29 -- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 __ ._.._ __.—__ ------ CONDITIONS . ___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 ER ABANDONM 5 56 THE MARKED ITEMS REPRESENT VIOLATI,OIN�S-�A.ND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR Lj VI 58 59 MINOR VIOL. VIOL VIOL. OFFICE: RECEIVED BY: TITLE:x, �f�' PHONE: RECK: 5/m O HUT-3 ORIGINAL