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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT WSAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCK205 PHONE TNO. 468-3423 ON, CA COUNTY # SITE NAME: ( Q INSPECTION DATE: SITE ADDRESS: S�-s CITY/STATE/ZIP yJ� CHANGES SITE/OWNER/PERMIT? YES NO TANK pt/ TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF SPECTION SITE COMPUTER# NUM BERltl.13-d/ NUMBER NUMBER NUMBER PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CO NTS PERMIT TO OPERATE MAJOR MINOR1 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 1g -- PIPING 1 20 `� -- INVENTORY RECONCILIATION 21 22 --- TANK GAUGING 23 24 - --- -- APPROVED RESPONSE PLAN 25 26 - - -- ----------____.. UNAUTHORIZED RELEASE OCCURRENCE 27 28SAMPLING 30 29 30 -- ---- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 - --- "- ------- -- SAFETY HAZARD CONDITIONS ABATED 37 ------ TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 9 FLAMMABLE VAPORS REMOVED -- --- ACCESS LOCATIONS SEALED 2 - - `--"--" POWER DISCONNECTED 3 - ---- OWNER/OPERATOR MONITORING - --�-- ---- PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS t56 PIPING FLAMMABLE VAPORS REMOVED ---- ----------- UNAUTHORIZED RELEASE ---- SAMPLING IMPROPER ABANDONMENT - - SYSTEM STATUS(MUST MARK ONE) �"------ THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: MAJOR 57 MINOR 8 NO 59 VIOL VIOL. ElVIOL.❑ OFFICE: INSP;_ 6 IHCEi*VEDY: 7 �0TITLE: PHONEUUVV/ RECK: HUT-3 ORIGINAL 5/88 51