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UNDERGROU.. TANK PROGRAM OFFICIAL INSP TION REPORT INSAN JOAQUIN HEALTH DISTRICT COUNTY 1601 E. HAZELTON AVE - NAME �� 1 STOCKTON, CA 95205 PHONE NO. 468-3423 COUNTY # SITE NAME: oiCI �, °>� r� INSPECTION DATE: � �.%J' SITE ADDRESS: r ��! ! r% j �f,,,, � f- CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO ANK FORM A AND/OR B SUBMITTED? N TANK T NK ANK COMPUTER COMPUTER OMPUTER TYPE OF INSPE TION SITE COMPUTER # NUMBER NUMBER COMPUTER PER # MBER PER BER PER # R # EXP. DATE EXP. DATE EXP. DATE OPERATIONAL TANK TANK CONTENTS EXP, DATE PERMIT TO OPERATE MAJOR MINOR 1. 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 _.m 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 -- --..m 19 20 — — ----- INVENTORY RECONCILIATION 21 22m-- _ 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 36 CONDITIONS ABATED ---------- _._ 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 36 39 FLAMMABLE VAPORS REMOVED 40 _ CESS 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 SAMPLING51 54 _ _... IMPROPER ABANDONMENT 55 56 _. SYSTEM STATUS (MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: MAJOR 57 MINOR 58 59 VIOL. � VIOL. VIOL. ❑ OFFICE: JINSP-CIV _ -5-//,R RECEIVED BY:LE: X15 PHONE: A" RECK: HUT -3 ORIGINAL 5/aa O M