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UNDERGROU07ANK PROGRAM OFFICIAL INSPIVION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. ^ COUNTY NAME STOCKTN, CA n PHONE OO. 468-34203 COUNTY # C,��I SITE NAME:p f ' INSPECTION DATE: lr V / SITE ADDRESS: /�/ 5 w, j,Jl CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK 07ZTANK TANK T ANK FORM A AND/OR B SUBMITTED? - COMPUTER COMPUTER OMPUTER COMPUTER T PE OF INSPECT I SITE COMPUTER# NUMBER 'y 1 ��Q� NUMBER �. NUMBER NUMBER ib � PER#�1'1'-(� PER # PER# PER # FC[�►�1 G(sc 7Z J G� EXP.DATE EKP.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 8 APPROVED MONITORING SYSTEM 9 10 2coo � _ MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 6 MONITORING RECORDS MAINTAINED 15 16 -- - ACCESS CASING SECURED 17 18 �- PING _ 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 PROVED 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 mi37 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 WANK CLOSURE REMO MATERIALS 4647 PIPING 48 149 FLAMMABLE VAPORS REMOVED 50 _- UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 -- - ,- IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Q MAJOR 57 MINOR 58 NO v VIOL. ❑ VIOL. ❑ VIOL. OFFICE: INSP: Qi�)'J /f — RECEIVED BY: -- TITLE: (r { } ? E: TECK: HUT-3 ORIGINAL sea O