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UNDERGROUtWK PROGRAM OFFICIAL INSPW§WN REPORT JOAQUIN HEALTH DISTRICTWW 1601 E. HAZELTON AVE. STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: SITE ADDRESS: p CITY/STATE/ZIP Q, CHANGES SITE/OWNER/PERMIT? YES NO TANK �y/ TANK b7i TANK 03 TANK FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK OPERATIONAL TANK M MAJORR 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 10MONITORINGSYSTEM11 12 _ - --- - - --- APPROVEDMONITORFREQUENCY 13 14 - ------- MONITORINGRECORDSMAINTAINED 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 36 _... _ .....__.._._-... CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 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 CQRRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL. OFFICE: INSP: RECEIVED BY: TITLE: PHONE: BECK: 5/88 ©M HUT-3 OWNER'S COPY