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UNDERGROU' �-NK PROGRAM OFFICIAL INSPECT'^N REPORT s 4 JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 PHONE NO. 468-3423 SITE NAME: ��5 fC tz U c INSPECTION DATE: / SITE ADDRESS: 1 i_ 1 } 0 () CfTY/STATE/ZIP Cp�9 J�3 7>7 CHANGES SITE/OWNER/PERMIT? YES NO TANK r i TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER JCOMPUTER COMPUTER COMPUTER TYPE OF INSPE TION SITE COMPUTER# NUMBER(006 NUMBER NUMBER NUMBER ��JJ PER# ,��i PER# PER# PER# /2Q e., �� EXP.DAT EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANKCONTENTs MAJOR I 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 17 118 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 133 34 SAFETY HAZARD 35 38 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 1 139 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 41 r43 POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 _ FLAMMABLE VAPORS REMOVED 50ME UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 _ . IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED S SYSTEM STATUS(MUST MARK ONE) FOLL WS: O a MAJOR 57 MINOR NO 59 VIOL. ❑ VIOL. ❑ VIOL b" f%U ' e� ^— 4A P-C %— L P o -e— Oti..� (- OFFICE: INSP:tVX RECEIVED Y: SNFvAmo;vkn �� L4 TITLE:/5714y / PHONE: RECK: HUT-3 ORIGINAL _",,,�,� 5/w O,