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1NDERGROl,""D TANK PROGRAPA OFFICIAL INS--CTION REPOPr- SAN JOAQUIN HEALTH DISTRIC 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO- 468-3423 ;ITE NAME. IWX�le INSPECTION DATE. v1A) ;ITE ADDRESS.- CITY/STATE/ZIP 1,2- an� 7, CHANGES SITE/OWNER/PERMIT? YES NO TK TANK TANK TANK -ORM A AND/OR B SUBMITTED? COMPUTE IR lCOMPUTER COMPUTER COMPUTER YPE ONUMBE�oo NUMBER NUMBER NUMBER PER #F INS J--[siTE COMPUTER ir , �;i6)j_ ER # PER# PER# ,_,t EXP.DATE EXP.DATE EXP.DATE EXP.DATE Frggg"von, TANK CONTENTS --------- ---------- OPERATIONAL TANK MAJOR MINOR . all PERMIT TO OPERATE 1 2 . CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 110 MONITORING SYSTEM 11 112 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 1' 1 5 -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 r.CONDITIONS ABATED 37 I I TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED _41 427 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 ----------- ?g,Ng N 9� eN to a K. -g PERMANENT TANK CLOSURE Its REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 149 FLAMMABLE VAPORS REMOVED 50 MINA UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS 'SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR MINOR Ju No F-] VIOL. A6 VIOL. ❑ VIOL- JINSP- RECEIVED BY: OFFICE: ✓ 71-ri rz, 'o ve -p-H-n-i IPF K