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fl i UNDERGROU NK PROGRAM OFFICIAL INSP TJ4N REPORT _ V JOAQUIN HEALTH DISTRIC" 1601 E. HAZELTON AVE. L STOCKTON, CA 95205 COUNTY # COUNTY NAME a PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: l (� l,� C SITE ADDRESS: .. /'z G, CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES N TANK J TANK e);2— TANK 3 TANK FORM A AND/OR B SUBMITTED? COMPUT/•J COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTIONfJ SITE COMPyI # PER# PER # PER# PER# EXP DATE EXP DATE EXP DATE EXP DATE 'nal OPERiQTIONAL TANK raNx coN-reNTs 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 _ 4—~ ACCESS LOCATIONS SEALED 41 42 - -- POWER DISCONNECTED 43 - OWNER/OPERATOR MONITORING 44 45 0c I 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: 159 57 58 VOR IOL. F] VIO. ❑ VOL.OR No ❑ IN , RECEIVED BY: OFFICE: ' TITLE: �4 moi T PHONE: BECK: sass C HUT=3 ' ORIGINAL