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UNDERGROUa TANK PROGRAM OFFICIAL INSP TION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAMES'o , ✓ STOCKTON, CA 205 '7 N/N PHONE NO. 468-3 423 COUNTY # 3q SITE NAME: S•�7 O$'17 INSPECTION DATE: SITE ADDRESS: y3 % C Ms er Sf CITY/STATE/ZIP efcc CA Q320.z CHANGES SITE/OWNER/PERMIT? NO TANK O t TANK 0-2 TANK 03 TANK FORM A AND/OR B SUBMITTED? G1-00�5' COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTIONSITE COMPUTER NUMBER NUMBER/ NUMBER(a�O NUMBER 2 PER# '.� PER# l J PER# �7 PER 1 # O✓ EXP.DATE W-� EXP.DATE �' EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR PERMIT TO OPERATE 1 p " -- RANGE IN CONDITIONS TO OPERATE 3 4 _----- _--"--- APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES --"- APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 ""-----� APPROVED MONITOR FREQUENCY 13 14 --"---'— MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 1718 PIPING 19 20 INVENTORY RECONCILIATION 21 122 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 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 139 FLAMMABLE VAPORS REMOVED 40 _ ACCESS LOCATIONS SEALED 41 142 -- POWER DISCONNECTED 43 —"— OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 149 FLAMMABLE VAPORS REMOVED 50 j UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 '-- IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS IMUST MARK ONE) FOLLOWS: Z / ewmAe. QN. Sy C s MAJOR 57 MINOR 58 NO 59 GtG VIOL. [jVIOL ❑ VIOLpr -6m OFFICE: INSP: RECEIVED BY: C�'iOrrliS yn. TITLE: )I? Z!W-5' PHONE: BECK: HUT-3 OPIGIP!,-.L - s,ea 0,