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UNDERGROUNr% TANK PROGRAM OFFICIAL INSPE^TION REPORT 7 0 /0 /%j ";AN JOAQUIN HEALTH DISTRICT y 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: ht geRTg /y Ale,4 , g , / ;aAfDN INSPECTION DATE: SITE ADDRESS: �S ` / i �//_ CITY/STATE/ZIP C.A �s ZD6 CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMP / COMPUTER 2 COMPUTER COMPUTER NUMBER 0 D NUMBER p NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER r��/J pER 8 /a '� PER# PER# EXP.DATE EXP.DATE!/ EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS 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 18 PIPING 19 20 INVENTORY RECONCILIATION 21 122 TANK GAUGING 23 124 APPROVED RESPONSE PLAN 25 26 _ UNAUTHORIZED RELEASE OCCURRENCE 27 28 LL 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 1 139 FLAMMABLE VAPORS REMOVED W44475 ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONffORING ------- PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING qg qg FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 _ SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ MOL- OFFICE: IOLOFFICE: INSP: RECEIVED BY: TITLE: PHONE: BECK: HUT-3 ORIGINAL O'