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UNDERGROUALTANK PROGRAM OFFICIAL INSP TION REPORT SAN JOAQUIN HEALTH DISTRIC7� 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: Cv eG P INSPECTION DATE: SITE ADDRESS: ( � G ff ' CITY/STATE/ZIP rV� r- A �cC S CHANGES SITE/OWNER/(PERMIT? YES NO TANK 3 TANK e-1 TANK 5 TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER PER # PER# PER# PER # KL EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS ��9/ MAJOR MINOR Z.� UL rnt A U. 0. PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES 71 APPROVED MONITORING SYSTEM MONITORING SYSTEM APPROVED MONITOR FREQUENCY � s MONITORING RECORDS MAINTAINED 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 HAZARD35 36 CONDITIONS ABATED 37 - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 130 139 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41r45 POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 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 p SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 58 59 MAJOR 57 MINOR NO VIOL. VIOL VIOL. El OFFICE: INSP- l RECEIVED BY: TITLE�� PHONE: BECK: HUT—3 ORIGINAL siaa O�