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UNDERGROUND `NK NK PROGRAM OFFICIAL INSPEG -1NREPOKI �,N JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. Itd STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 466,8-3423 SITE NAME: INSPECTION DATE:f 15r-1 SITE ADDRESS:22-35E. �a CITY/STATE/ZIP G � CHANGES SITE/OWNER/PERMIT? YES NO TANK f TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTE # PER# PER# PER# PER# L EXP.DATE EXP.DATE E DATE E DATE OPERATIONAL TANK TAW CONTENM MAJOR MINOR +-F 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 11 112 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 �` _._._.___..__... ,_..._:. ,...._ _------ __________.,._.,..___.._.._ CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 41 42 _..: _____. .____—,_._-__. __.... -. _--..............-. POWER DISCONNECTED OWNER/OPERATOR MONITORING 144 145 m r; r PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 _ v_-__ UNAUTHORIZED RELEASE 51 52 _ __ SAMPUNG 53 54 _._.__.... IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 58 9 MAJOR 57 MINOR NO i VIOL. ❑ VIOL ❑ VIOL i 1 OFFICE: INSP: RECEIVED BY: TITLE: E-A01 PHONE: BECK: -as O HUT-3 ORIGINAL