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UNDERGROU'.TANK PROGRAM OFFICIAL INSP"TION REPORT U.-AN JOAOUIN HEALTH DISTRIC-i 1601 E. HAZELTON AVE. COUNTY NAME � STOCKTON. CA 95205 COUNTY # cy J � PHONE NO. 468-3423 -� SITE NAME: INSPECTION DATE:._ SITE ADDRESS: // CITY/STATE/ZIP c �� 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 # //j3 ` PER# PER# PER # EXP DATE EXP DATE EXP DATE EXP DATE OPERATIONAL TANK TANK cou�Nzsu� MAJOR MINOR PERMIT TO OPERATE 1 2 - CHANGE IN CONDITIONS TO OPERATE 3 4 .----- APPROVED CONSTRUCTION 5 ,- 6 WRITTEN MONITORING PROCEDURES 7 S 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 28 - UNAUTHORIZED RELEASE OCCURRENCE 27 28 -- SAMPLING 29 APPROVED TANK REPAIRS 31 32 _----._._�_ __. -----_-.-_-.. --- - --- --- --- UNAUTHORIZED RELEASES REPORTED 33 A34 SAFETY HAZARD 35 36 _- --__ _ -- -- --- - ---- - CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE ,, REMOVAL OF RESIDUAL 36 39 --- FLAMMABLE VAPORS REMOVED 40, --- ACCESS LOCATIONS SEALED 41 42 -- POWER DISCONNECTED 43 -- OWNER/OPERATOR MONITORING 44; 45 04 PERMANENT TANK CLOSURE ffr REMOVAL OF RESIDUAL MATERIALS 146 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 5t 52 SAMPLING 53 54 -- IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 711 Az 57 58 MAJOR MINOR NO 59 C VIOL_ VIOL. VIOL OFFICE: INSP: /O� RECEIVED BY: TITLE: PHONE: BECK: 5fe8 C, . HUT-3 ORIGINAL