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UNDERGROUOTANK PROGRAM OFFICIAL INSP TION REPORT SAN JOAQUIN HEALTH DISTRICTW 1601 E. HAZELTON AVE. COUNTYNAME c� PHONE ONO4689 423 COUNTY #1-3�7 SITE NAME: + I 7tL /a - ti 0 INSPECTION DATE: SITE ADDRESS: -7 7 S CITY/STATE/ZIP s f CHANGES SITE/OWNER/PERMIT? YES NO TANK p TANK Q -1- TANKp TANK � FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER" TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER r•p,n, ,� , ff C� I 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 MONITORING PROCEDURES 7 g APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 r,_ PIPING 19 20 r% _. INVENTORY RECONCILIATION 21 22 DY' TANK GAUGING 23 24 _. APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 132 UNAUTHORIZED RELEASES REPORTED 33 134 — SAFETY HAZARD 35 136 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE. REMOVAL OF RESIDUAL 138 39 FLAMMABLE VAPORS REMOVED 4(l ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 156 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS{MUST MARK ONE) FOLLOWS: k - 57 58 59 MAJOR No VIOL. ❑ VIOL..MINOR ❑ VIOL.❑ OFFICE: INSp4o RECEIVED BY: TITLE: F PHONE: BECK: HUT-3 ORIGINAL sraa C3