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UNDERGROU TANK PROGRAM OFFICIAL INSP�TION REPORT SAN JOAQUIN HEALTH DISTRIC G 1601 E. HAZELTON AVE. COUNTY # .� STOCKTON, CA 95205 COUNTY NAME PHONE NO- 468-3423 g22,��- (Z SITE NAME: � � � � � Qp I(�'� INSPECTION DATE: / S 11�! sT Pi�?'�C/CSd�^ F�-SS CITY/STATE/ZIP 6s R Y"3 7 SITEADDRESS: 6 TANK TANK CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK COMPUTER COMPUTER COMBER R COMPUTER FORM A AND/OR B SUBMITTED? NUMBE1RO n c UMBE 000 NUMBER TYPE QF INSPECTION SITE COMPUTER# U37 pER # s� PER# PER# d A e- o'j EXP.DIAATNZxi� Q EXP DATE Imo' I EXP.DATE EXP.DATE TANK CONTENTS OPERATIONAL TANK 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 HAZARD35 36 --- ---_---"- CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL P45 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING 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: +-P M 57 68 59 VIOLlR Li MINOR ❑ VIOL OFFICE: INSP:e / R IVED BY: TITLE: E: C 1 0 RECK: HUT-3 ORIGINAL