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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT WSAN JOAQUIN HEALTH DISTRICW 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 PHONE NO. 468-3423 COUNTY #„��' SITE NAME: �� 6 INSPECTION DATE: SITE ADDRESS: aSDE CITY/STATE/ZIP01 CHANGES SITE/OWNER/PERMIT? YES NO TANK J TANK TANK TANK FORM A AND/OR B SUBMITTED? f' S COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COM TER# NUMBER NUMBER NUMBER NUMBER S PER# PER # PER# PER# EXP.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 M0 ORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 - -- -- MONITORING SYSTEM 11 12 -- APPROVED MONITOR FREQUENCY 13 14 - - "- MONITORINGRECORDSMAINTAINED 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 - -- ""- 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 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 46 47 PIPING 48 49 -- - -- FLAMMABLE VAPORS REMOVED 50 - ------._—_-- UNAUTHORIZED RELEASE 51 52 --- UNAUTHORIZED -. - -" -- 53 54 IMPROPER ABANDONMENT 55 56 `-"- "--- THE MARKED ITEYS REPRESENT VIOLATIONS AND MUST E C RRECTED AS ' SYSTEM STATUS(MUST MARK ONE) FOLLOWS:57 58 59 U UCSD GC QST MAJOR MINORNo VIOL ❑ VIOL. ❑ VOL.D OFFICE: � INSP:14- RECEIVED � / l � �i'l TITLE: ,�61-t4j PHONE: BECK: HUT-3 ORIGINAL - sisa