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UNDERGROUN NK PROGRAM OFFICIAL INSPE ON REPORT WN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 PHONE NO. 468-3423 COUNTY # 3 SITE NAME: INSPECTION DATE: SITE ADDRESS: Y% CITY/STATE/ZI 9 -3�6 CHANGES SITE/OWNER/PERMIT? YES NO TANK I TANK '7/ TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTEFI` COMPUTER COMPUTER TYPE OF INSPECTION _ SITE COMPUTER# NUMBER ? NUMBEF�✓�O NUMBER NUMBER .2 /J PER# ,^/e( PER# PER# PER# 3 EXP.DATIP 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 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 -- - - SAMPLING 29 130 1 - APPROVED TANK REPAIRS 31 132 UNAUTHORIZED RELEASES REPORTED 33 134 SAFETY HAZARD 35 136 ' CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 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 SAMPUNG 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: so MAJOR 57 MINOR 58 NO 59 , VIOL. ❑ VIOL ❑ VIOL. OFFICE: INSP: Z / RECEIVED BY: TITLE:)e,�:-e PHONE: RECK: HUT-3 ORIGINAL seas ©'