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LINDERGROU# TANK PROGRAM OFFICIAL INSTION REPORT SAN JOAQUIN HEALTH DISTRICW 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 C, PHONE NO. 468-3423 COUNTY # SITE NAME: T S INSPECTION DATE: SITE ADDRESS: IGL /Dp V CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES LNO ANK TANK TANK ) TANK �s FORM A AND/OR B SUBMITTED? COMPUTER COMPUTE FY COMPUTER COMPUTER I �S TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER // PER# PER# PER# PER# ` 4�� EXP.DATE E OXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CNTENTS 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 INVENTORY RECONCILIATION 21 22 ✓ - - ✓ "" TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 _ "- UNAUTHORIZED RELEASE OCCURRENCE 27 28 - SAMPLING29 30 - -- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 '—" _. SAFETY HAZARD 35 36 - DITIONS ABATED 37 - - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL N444t5ff FLAMMABLE VAPORS REMOVED -- - - ACCESS LOCATIONS SEALED POWER DISCONNECTED - - OWNER/OPERATOR MONITORING PERMANENT TANKCLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 qg --- 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: -LI- MAJOR 57 MINOR NO 59 j VIOL. ❑ VIOL. VIOL❑ OFFICE: INSP�" _ RE D BY: I �7 N TITLE: ,/)C PHONE: PECK: HUT-3 /C__)ORIGINAL sisa ©