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UNDERGROUf TANK PROGRAM OFFICIAL INSPF-TION REPORT SAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. STOCKTON, CACOUNTY NAME S" PHONE PHONE ENO. 468-934235205 68934203 COUNTY # it SITE NAME: � ,� &/ q A01 INSPECTION DATE: SITE ADDRESS: /�}G) ,�2> C� CITY/STATE/ZIPS f-p CK�►� C/g gSoZ CHANGES SITE/OWNER/PERMIT? YES NO TANKC) / TANK p i1- TANK 0_3 TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPEj1 OF INSPECTION SITE COMPUTER# PER # PER# PER# PER# / t 0-" 1 W✓ 0 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS 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 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS r5l 47 PIPING 49 FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE 52 SAMPLING54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 58 59 MAJOR NO VIOL. E:] VIOLL..R ❑ VIOL.❑ OFFICE: INSP: RECEIV Y: GL y 'i' TITLE: L,2� P E: BECK: HUT-3 ORIGINAL 588 (D