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UNDERGROU' TANK PROGRAM OFFICIAL INSPr ''.TION REPORT _ SAN JOAQUIN HEALTH DISTRICI..i 1601 E. HAZELTON AVE. COUNTY NAME Sar,Y, �9 a STOCKTON, CA 205 PHONE N0. 468 3423 COUNTY #g SITE NAME: INSPECTION DATE: l B SITE ADDRESS: FRE CITY/STATE/ZIP ,"�Be,,wy7C� l� D CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK �„ 9 TANK FORM AAND/OR B SUBMITTED? COMP UTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER F o oe�i 9 PER# I I/9 PER# PER# PER# EXP.DATE- EXP.DATE EXP.DATE EXP,DATE OPER TIONAL 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 T- -APPROVED MONITORING SYSTEM --9-'-10 -777 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 23 124 APPROVED RESPONSE PLAN 25 126 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 38 39 FLAMMABLE VAPORS REMOVED 444n ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING 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 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: §7 S8 VIOL. 59 o _ MAJOR IM MINOR In VIOL. LJ VIOL LTJ OFFICE: INS RECEI_FAD ca 0 TITLE: PHONE: RECK: HUT-3 ORIGINAL sig OM