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UNDERGROUNfaNK PROGRAM OFFICIAL INSPEf ON REPORT N JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY # j STOCKTON, CA 95205 COUNTY NAME PHONE NO. 468-3423 ` ` INSPECTION DATE: 7W SITE NAME: S��7G 7 SNS/T r SITE ADDRESS: J�e�pl fill �c„Q,S6A) f]$S CITX/$TATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK Z TANK 3 TANK 151 7. FORM AAND/OR B SUBMITTED? COMPUTER �� NOIMPUTER COMPUTER r !� COMPUTER NUMBER jD ! NUMBE�tpo 16 wo NU 5%V ,ypbb TYPE OF Oil OF INSPECTION SITE COMPUTER# PER # pl tl— PER / �Q,(, ( PER �Qp�.'y P C.�/" Lr¢-//J'T S EXP.DATE EXP.DATE EXP, ATE ATE TANK CONTENTS OPERATIONAL TANK'-Q c./t/S MAJOR MINOR v u X PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 -. -- -- APPROVED CONSTRUCTION 5 6 - — WRITTENMONITORINGPROCEDURES 7 8 -- APPROVED MONITORING SYSTEM 9 10 -- 't/ I V 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 2 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 - - -- SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 - UNAUTHORIZED RELEASES REPORTED 33 34 -- - - SAFETY HAZARD 35 38 _._.. _.. . . _..___. 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 L 47 _ ..... PIPING "" - FLAMMABLE VAPORS REMOVED — UNAUTHORIZED RELEASE 52 -.. - ....____._... --- SAMPLING 54 " IMPROPER ABANDONMENT 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST bECORRE ED S SYSTEM STATUS(MOST MARK oNE) FOLLOWS: 5 58 59 MiM MAJOR MINOR NO VIOL VIOL ❑ VIOL❑ RECVE OFFICE: INSP: /,i a- 4REC;K: TITLE: � PHONE: siae HUT-3 ORIGINAL