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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT WSAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. STOCKTON, CA 95205 COON TY # Luu[ I na 4000I I RAMS I 86-(.f\L-I'\— YnVrv� rvv. 4vo-w�.. SITE NAME: i9 , INSPECTION DATE: Q SITE ADDRESS: �� CITY/STATE/ZIP 57'bk-69-2, c?J726 Z 222 E e V CHANGES SITE/OWNER/PERMIT? E NO TANK TANK TANK TANK COMPUTER COMPUTER FORM AAND/OR B SUBMITTED? COMPUTER NUMBER COMPUTER NUMBER NUMBER NUMBER TYrF OF INSPECTION SITE COMPUTE # 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 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 30 APPROVED TANK REPAIRS 31 32 -- UNAUTHORIZED RELEASES REPORTED 33 34 -- SAFETY HAZARD 35 38 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL -- FLAMMABLE VAPORS REMOVED ACCESS 1- CATIONS SEALED W4445i 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 SAMPLING 53 54 _.. .-_..__.__,___...._._._ IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEMSTATUS (MUST MARK ONE); (✓N -V pbstv4 FOLLOWS: �O Ui D�GI /byl,S MAJOR 579 MINOR NO 5 ❑ ❑ VIOL VIOL. VIOL. OFFICE: RECEIVED BY: PHONE: RECK: TITLE: sim []M NI IT—a ORIGINAL