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I UNDERGROUN- TANK PROGRAM OFFICIAL INSPF` -ION REPORT: \ ,gAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. STOCKTON, CA COUNTY NAME PHONE NO. a 893423 COUNTY # I SITE NAME: INSPECTION DATE: Ij o✓Ci e v r0 t+- _ -2'- SITE ADDRESS: b t S 11 t CITY/STATE/ZIP cc` t 3 CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK Z TANK TA FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER INUMBER TY P OF INSPECTION SITE COMPUTER#/• PER# PER# PER# PER# P�yv10 VGti /(//LJ (/I]5 EXP DATE EXP DATE EXP DATE EXP DATE li TANK CONTENTS OPERATIONAL TANK MAJOR MINOR 'l, t�D�-UL -', ba ;UL C✓es�r0^rss PERMIT TO OPERATE 1 2 u 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 _ I MONITORING RECORDS MAINTAINED 15 16 ' ACCESS CASING SECURED 17 18 { PIPING 19 20 Y INVENTORY RECONCILIATION 21 22 'I TANK GAUGING 23 24 — APPROVED RESPONSE PLAN 25 26 �- UNAUTHORIZED RELEASE OCCURRENCE - 27 28 _v _ SAMPLING 29 30. -_-.__ ----- APPROVED TANK REPAIRS 31 32' _ UNAUTHORIZED RELEASES REPORTED 33 34 _ p SAFETY HAZARD 35 36 _----_ — -- CONDITIONS ABATED - 37 II Ater �s ,)y;s x ,d'#��N�F�x '4 i3'a a �'1 $ 'k I TEMPORARY TANK CLOSURE "?#� '-� � '�'` ��'x`�Ts�z� �x s Y � ,�c -, .��._ :- � �. � REMOVAL OF RESIDUAL 38 39 - FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 --- POWER DISCONNECTED 43 - OWNER/OPERATOR MONITORING 44 45. I PERMANENT TANK CLOSURE wk ' RE46 47 PIPING 48 49 --- FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE tt - SAMPUNG IMPROPER ABANDONMENT THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 59 MINOR NO - VIOL. ❑ VIOL. VIOL.❑ { V OFFICE: INS`% RECEIVED BY: TITLE: ` PHONE: BECK: �J seas O ' HUT-3 _ ORIGINAL