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UNDERGROU' TANK PROGRAM OFFICIAL INSPr-'''TION REPORT `..✓SAN JOAQUIN HEALTH DISTRICI, 1601 E. HAZELTON AVE. COUNTY NAME JGfiyL 40 CL STOCKTON, CA 95205 COUNTY #,3�' PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: 6 SITE ADDRESS: O 7 N, 1 1< l/ !/� CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK 6 / TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER PER# PER# PER# PER# l��C•(J��(/ c�.� / �CJ EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR PERMIT TO OPERATE 1 2 _-,..__- CHANGE IN CONDITIONS TO OPERATE 3 4 __----- APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 g _„_____— APPROVED MONITORING SYSTEM 9 10 _7—t: 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 34 SAFETY HAZARD 135 136 CONDITIONS ABATED V, 37 - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ___...__,.. . _... __.._. __- _.____.-- _ ACCESS LOCATIONS SEALED 41 42 _...._ POWER DISCONNECTED 43 ------`-'-`-`'-- OWNER/OPERATOR MONITORING 44 -4 45 PERMANENT TANK CLOSURE ` m' REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 ti~^ —"� --_w_____ ____ ____ _______,_..____- UNAUTHORIZED RELEASE 51 52 � SAMPLING 153 54 IMPROPER ABANDONMENT 155 56 S THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: znez 58 59 MAJOR 57[El MINOR NO VIOL. VIOL. VIOL LJ OFFICE: INSP: RECEIVED BY: TITLE: E 14 c PHONE: BECK: i HUT-3 ORIGINI,-.LL 5/88 (