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UNDERGROUND ' IK PROGRAM OFFICIAL INSPEC i N REPORT !�IWIV JOAQUIN HEAoLITH DISTRICT1601 E. HAZELTAVE. �✓ STOCKTON, CA 95205 COUNTY # j COUNTY NAME PHONE NO. 468-3423 f INSPECTION DATE: _ SITE NAME: '�` SITE ADDRESS: 4, 137 CITY/STATE/ZIPj/V 9 � L i.�f� P� TANK TANK TANK CHANGES SITE/OWNER/PERMIT? YES NO TANK COMPUTER r" COMPUTE NOMmp BERER COMPUTE �C! NUMBE�ei FORM AAND/OR B SUBMITTED? NUMBE140) NUMBE �� / f PER # TYPE OF INSP CTION I SITE COMPUTER# PER#gift PER# PER# � D�i Lr EXP.DATE AO EXP.DATE .r EXP.D E),0 XP.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 p- W ---- M— SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 W_.-___� ..._. ...._.. ... 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 mm 43 OWNER/OPERATOR MONITORING 144 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 149 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING53 54 IMPROPER ABANDONMENT THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 1 Jezpil kil MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ V1OL. OFFICE: INSPA/ RECEIVED BY: TITLE: PHONE: PECK: else OM HUT-3 OWNER'S COPY