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UNDERGROU SAN JOAQUIN HEALTH D STR C-Pw REPORT 1601 E. HAZELTON AVE. COUNTY #� STOCKTON, CA 95205 COUNTY NAME C © 1 0 PHONE NO. 468-3423 INSPECTION DATE:J? I q SITE NAME: <--f- SITE ADDRESS: i// CITY/STATE/ZIP` f.� G C-lV TAN TANK TANK �3 TANK CHANGES SITE YES NO COMPUTER COMPUTER COMPU R NUOMBE� FORM AAND/OR B SUBMITTED? NUMBERK6�:r NUMBER 0,L• NUMBER 5O,L, PER # PE TYPE OF INSPECTION SITE COMPUTER# PER # PER# p.DATE QEXP.DATE EXP.DATE EXP DATE TANK CONTENTS OPERATIONALTANK MAJOR MINOR PERMIT TO OPERATE 1 2 .-_-- CHANGE IN CONDITIONS TO OPERATE 3 4 - T _ APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 ✓ --,- APPROVED MONITORING SYSTEM 9 10 --, --- / MONITORING SYSTEM 11 12 -� V APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 - - 19 20 PIPING - 22 INVENTORY RECONCILIATION - -- _� 23 24 TANK GAUGING ---- "-"- APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED.RELEASE OCCURRENCE 27 28 30 SAMPLING 29 ---- - 31 32 ._.._ __- APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED 35 36 33 SAFETY HAZARD --- -- CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED40 ---- ------- - ACCESS LOCATIONS SEALED 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 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST 8E CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 59 MAJOR MINOR NO VIOL. VIOL VIOL.❑ �Se RECEIV BYw TITLE: OFFICE: INSPFOL.!✓ PHONE: - RECK: ',�,�..(.S, 5/88 'JUT-3 ORIGINAL