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UNDERGROUND NK PROGRAM OFFICIAL INSPEC' )N REPORT N JOAQUIN HEALTH DISTRICT • 1601 E. HAZELTON AVE. STOCKTON, CA COUNTY NAME PHONE NO. 468-934235205 8934203 COUNTY # SITE NAME: � �7v y INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# /t G(o -O/ PER# !(G G-Cl R# PER# I-e //6:1 C• EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK coNreNTs MAJOR I 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 —f-� 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 27 128 - SAMPLING 29 130 _ APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 _ SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 144 145 �T ERMANENT TANK CLOSURE REMOVAL O 46 47 PIPING 48 149 - ----- FLAMMABLE VAPORS REMOVED 50 FEEMINA 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: 57 58 59 MAJOR MINOR NO - VIOL. ❑ VIOL. VIOL.❑ c e � Ile 4 AG OFFICE: INSP: RECEIVED BY: TITLE: /PGs PHONE: RECK: HUT-3 ORIGINAL sisa O