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UNDERGROU 1 NK PROGRAM OFFICIAL INSPbOON REPORT N JOAQUIN HEALTH DISTRIC 601 E HAZELTON AVE COUNTY NAME I 1STOCKTNO CA 3x5 COUNTY #�?� PHONE N0. 468--34423 SITE NAME: SITE ADDRESS: �C Q CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK ( TANK FORM A AND/OR B SUBMITTED? SYSTEM STATUS (MUST MARK ONE) MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL.N PER # r COMPUTERCOMPUT�NUMBERJNUMBER EXP. DATE E OF INSPECTION TYPE SITE OOMPI,�TER ?I 1f XE f% PER # � or PER # qZ�-Ala O 0 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 8 APPROVED MONITORING SYSTEM 9 10 T _. MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 118 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 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS PIPING FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE SAMPLING IMPROPER ABANDONMENT 46 48 50 51 53 55 SYSTEM STATUS (MUST MARK ONE) MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL.N OFFICE HUT -3 i�Gi E,,�TION DATE: 47 49 52 54 oe,- 56 GVW THE MARKED ITEMS RE�P+RES VIOLATIONS AND MUST BE CORRECTED AS y 1NSP:. TITLE:5' ORIGINAL BECK: 5/88 61 TANK TANK COMPUTER COMPUTER NUMBER NUMBER PER # PER # EXP. DATE EXP. DATE 47 49 52 54 oe,- 56 GVW THE MARKED ITEMS RE�P+RES VIOLATIONS AND MUST BE CORRECTED AS y 1NSP:. TITLE:5' ORIGINAL BECK: 5/88 61