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UNDERGROUNir TANK PROGRAM OFFICIAL INS'- -TION REPORT ,AN JOAQUIN HEALTH DISTRIC f 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP . GA CJS 3 CHANGES SITE/OWNER/PERMIT? YES NO TANKTANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTErr5 0 COMPUTER COMPUTER COMPUTER TYPE OF INS P CTION SITE COMPUTER # NUMBER '00 NUMBER NUMBER NUMBER VK� j J PER # PER # PEI # PER # l__ EXP-DATE EXP.DATE EXP.DATE EXP.GATE OPERATIONAL TANK TANK ONTENTs 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 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 33 134 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 mm ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 155 156 THE MARKED ITEMS REPRESEI>IT VIOLATIONS AND MUST BE ORRE TED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:58 9 __ MAJOR 5 7 MINOR NO _ VIOL. ❑ VIOL. ❑ VIOL. OFFICE: INSP: w V RECEIVED BY: TITLE: /zec 5 PHONE BECK: HUT-3 ORIGINAL 5/W O