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UNDERGROLIWNK PROGRAM OFFICIAL INSVWION REPORT AN JOAQUIN HEAQLrTH DISTRIC 1601 E. HAZELTAVE. STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-3423 INSPECTION DATE". SITE NAME: CITY/STATE/ZIP SITE ADDRESS: TANK 2 TANK TANK CHANGES SITE/OWNER/PERMIT? YES NO TANK COMPUTER COMPUTER COMPUTER COMPUTER FORM A AND/OR B SUBMITTED? NUMBER NUMBER NUMBER ' NUMBER � PER# TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER# __ �;•y�' EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK CONTENTS OPERATIONAL TANK MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 ---- ----- WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 --------- 13 14 - --- APPROVED MONITOR FREQUENCY MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 ---- - --- -- PIPING 19 20 22 INVENTORY RECONCILIATION 21 ------ 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 SAMPLING53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATION AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: c 59 MAJOR 57 58 56 NO VIOL. Leh VIOL ❑ VIOL❑ RECEIVED BY: INSP: OFFICE: �� y F -,/ TITLE: k�' � I_I PHONE: RECK: 5/88 HUT-3 OWNER'S COPY