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UNDERGROU 'TANK PROGRAM OFFICIAL INSP~"TION REPORT AN JOAQUIN HEALTH DISTRIM d = .. 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA"95205 ' T COUNTY # PHONE'NO. 468=3423 SITE NAME: � � INSPECTION DATE: SITE ADDRESS: �a O /� J � CITY/STATE/zip" CHANGES SITE/OWNER/PERMfT►?"YES NCV TANK TANK' TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER- PER UMBER_PER# PER# PER# PER#- EXP.DATE' EXP.DATE EXP.DATE EXP.DATE - OPERATIONAL TANK — TANK CONTEN75 ._. _ .e _ MAJOR MINOR x- 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 1.1 12 ' APPROVED MONITOR FREQUENCY a - 13 14 MONITORING RECORDS MAINTAINED r 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 28 SAMPLING 29- 30 _ 'APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED:.>; ",.? 33 34 SAFETY HAZARD" 35 136 CONDITIONS ABATED 37 = TEMPORARY TANK CLOSURE <� V m V _ REMOVAL OF RESIDUAL 38. 39 FLAMMABLE VAPORS REMOVED 40 ACCESS"LOCATIONS SEALED 41- 42 . POWER DISCONNECTED 43 pl {.. •. ; : : .. OWNER/OPERATOR MONITORINGc 145 PERMANENT TANK CLOSURE REMOVAL.OF RESIOUAL'MIATERIALS 46 47 PIPING" _ 48 49 _ r FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE 51 _ 52 - : SAMPLING 53 « 54 IMPROPER ABANDONMENT 3r" r�r 56 :.r z THE MARKED.ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST ONE} - � :r r • ~ ^^ MARK: FOLLOWS MAJOR" MINOR _5 =VIOL ❑ VIOLJ :VIOL ❑ - OFFICE INSP RECEIVED.BY: - � ;d TFLE: �//��\/ (� PHONE:. RECK: j HW 3 3 ORIGINAL.