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UNDERGIRCIgr TANK PROGRAM OFFICIAL L "TION�EP T , AN JOAQUIN HEALTH DISTR F- CG 1601 - HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO- 468-3423 SITE NAME: Il //' INSPECTION DATE: SITE ADDRESS: ` tr S CITY/STATE/ZIP CHANCES SITE/OWNER/PERMIT? YES NO TANK NK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER PER # PER # PER # PER # n� Gr r EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIO Al- 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 H APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 - - ----.-..-. _ _---- --------- APPROVED MONITOR FREQUENCY 13 14 -------_ _. MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 21; UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING29 30 _ __.._..__-___--. _.___---.__ .. ..._._.___..,_._.._._.__. APPROVED TANK REPAIRS 31 a2 ___.-.__ .__.. UNAUTHOHIZED RELEASES REPORTED a3 34 SAFETY HAZARD 35 36 CONDITIONS ABATED i/ 37 - _- TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 LAMMABLE VAPORS REMOVED 40 } ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED as - ___. .__.___. .... .._. .: OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING48 49 FLAMMABLE VAPORS REMOVED ------.._ UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 5.' 56 THE MARKED ITEMS REPRESS T VIOLATIONS AND MUST BE CORREC ED AS SYSTEM STATUS 1MUS7 MARK ONE) FOLLOWS: 57 MAJOR MINOR 58 NO-59 VIOL.—*'CdJ VIOL. VIOL.❑ OFFICE: INSP: CEIVE Y TITLE: HO L: RECK: r I� - 6� HUT-3 ORIGINAL /57ec. /5