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UNDERGROUILr TANK PROGRAM OFFICIAL INSPEr''ION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME too STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: G;II ics ru Lffi INSPECTION DATE: y cl g SITE ADDRESS: za ?' R_/ CITY/STATE/ZIP SKn CHANGES SITE/OWNER/PERMIT? YES NO TANK I Of TANK p 3 TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION ISITE COMPUTER# PER# PER# PER# PER# re m Oy t'- 1703 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTNTSMAJUR- MAJOR 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 MONITORING RECORDS MAINTAINED 15 16 ' ACCESS CASING SECURED 17 18 PIPING 19 j2O _ 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 W43 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 _- FLAMMABLE VAPORS REMOVED U RIZED RESIEA_iSE-F'!'D+'h '.�;PiY�4. 51 52 SAA O[ fyirwF^, 0 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 NO VIOL VIOL.R ❑ MINLR ❑ VIOL.❑ OFFICE: INSP RECEIVED BY: TITLE, l . _- PHONE: RECK: HUT-3 ORIGINAL 5'88 ©"