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UNDERGROUNf`ANK PROGRAM OFFICIAL INSPEr�10N REPORT %wAN JOAQUIN HEALTH DISTRICT .e ` 1601 E. HAZELTON AVE. CDSNTY NAME STOCKTON, CA 95205 COUNTY # 3� PHONE NO. 468-3423 SITE NAME: S' •e✓'4 aNG INSPECTION DATE: SITE ADDRESS: 7U�� CITY/STATE/ � kA4 A S3 / CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK f TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTERCOMPUTER COMPUTER / NUMBER p.l NUMBER ,3� NUMBER NUMBER TYPE OF INSPECTION SITE COMPIJTTE#. PER# PER# 04,,Cx PER# PER# fp/ EXP.DATE EXP.DATE O7L"' EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENrs MAJOFWLj MINOR .y 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 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ,C / ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 X TANK GAUGING 2 24 x 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 38 r43 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 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 SYSTEM STATUS(MUST MARK ONE) FOLLOWS: D 7 MAJOR MINOR 58 NO 59 VIOL. VIOL ❑ VIOL.❑ OFFICE: J6r 3 0 INSP: RECEIV � 7 TITLE: PHo rO y � BECK: HUT-3 ORIGINAL 5/88 (D