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UNDERGROU&TANK PROGRAM OFFICIAL INSPECTION REPORT AN JOAQUIN HEALTH DISTRIC7IF 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 ? PHONE NO. 468-3423 COUNTY # J SITE NAME: `Axon � �� PcCo / Z INSPECTION DATE: SITE ADDRESS: V ' N CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? NO TANK / h� FORM A AND/OR B SUBMITTED? 4/ TANK 2 TANK TANK COMPUTER COMPUTER COMPUTER TYPE INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER COMPUTER PER NUMBER �d� 11-16111 #p� PER# PER# PER# OPERATIONAL TANK TANK CONTENTS EXP.DATE' EXP.DATE- EXP.DATE EXP.DATE MAJOR 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 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 _ MONITORING RECORDS MAINTAINED 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 38 39 FLAMMABLE VAPORS REMOVED 40 - �- ACCESSLOCATIONSSEALED 41 42 _- ---'—' -'--- __ POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 - 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 ------------�_..-W 55 56 --------- - SYSTEM STATUS(MUST MARK ONE) ._..... THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: MAJ 57 NO VIOLOR ❑ 58 59 VIOLO.R ❑ VOL.❑ OFFICE: INSP: R CEIVED��— TITLE: PHO E: RECK: 1UT-3 ORIGINAL - siaa O�