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UNDERGROU�TANK PROGRAM OFFICIAL INSTION REPORT SAN JOAQUIN HEALTH DISTRIC� 1601 E. HAZELTON AVE. STOCKTON, CA 95205 COUNTY NAME COUNTY # 3Y �Q Q PHONE NO. 468-3423 SITE NAME: IVO r m . INSPECTION DATE: IoZD GD SITE ADDRESS: /'irti w CITY/STATE/ZIP Sk G)(! / 6 l �aQS CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE O�PECi�� SITE`/COMPUTER# PER# PER# PER # PER# 17 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR I MINOR PERMIT TO OPERATE 1 12 CHANGE IN CONDITIONS TO OPERATE 3 14 APPROVED CONSTRUCTION 5 16 _ WRITTEN MONITORING PROCEDURES 7 18 1 APPROVED MONITORING SYSTEM 9 110 MONITORING SYSTEM 11 112 APPROVED MONITOR FREQUENCY 13 114 MONITORING RECORDS MAINTAINED 15 116 1 _ ACCESS CASING SECURED 17 118 �_ w PIPING 19 20 r> INVENTORY RECONCILIATION 21 22 c7 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 132 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 44 145 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 155 156 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 40, 57 58 59 VIOL..MAJOR ❑ VIIOLL..R ❑ VIOL.❑ OFFICE: INSP RECEIVED BY: TITLE: 4j� PHONE: BECK: 5iaa HUT-3 4 OR GINAL O M