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LINDERGROU V"' TANK PROGRAM OFFICIAL INSPE.��-ION REPORT SAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: aG �a INSPECTION DATE: /1j/�✓ SITE ADDRESS: J CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK O/ TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMP TER# PER PER# PER # PER # EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS 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 11 112 APPROVED MONITOR FREQUENCY 13 114 MONITORING RECORDS MAINTAINED 15 116 ACCESS CASING SECURED 17 Ila PIPING 19 120 INVENTORY RECONCILIATION 21 122 1v_ _— TANK GAUGING 23 124 1 — -- APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 .---- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34SAFETY HAZARD HAZARD 35 36 CONDITIONS ABATED 37 NA TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 — FLAMMABLE VAPORS REMOVED 40 __�— _ - ___ - -.—•--.- - - -- ACCESS LOCATIONS SEALED 41 42 _- POWER DISCONNECTED M 43 -- OWNER/OPERATOR MONITORING 144 45 PERMANENT TANK CLOSURE ¢ -� F y.' REMOVAL OF RESIDUAL MATERIALS 46 47 _ PIPING 48 49 _ FLAMMABLE VAPORS REMOVED 50 ---- UNAUTHORIZED RELEASE 51 52 -- SAMPLING53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED A SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 9 58 MAJOR 57 MINOR NO 59 VIOL. ❑ VIOL ❑ VIOL OFFICE: INSP: j RECEIVED BY: r TITLE: to� PHONE: RECK: sees O ORIGINAL