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UNDERGROUND TANK OFFICIAL INSPECTION REPORT SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street Mailing Address: P.O.Box 388 COUNTY NAME ] /Sttkt° 468-3420c 1-0388 COUNTY #3 9 SITE NAME: s a f� ��r"rows !7C(�7r;�Y/� !1 INSPECTION DATE: 3 a -?5 SITE ADDRESS: 9 Jr. QCI�TY/STATE/ZIP S*�//-J", d 't' �l TU7� w7 CHANGES SITE YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? OMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# UMBER NUMBER NUMBER NUMBER ( 6 wvL 54)5 A�9Z} R'� PER# PER# PER# E P.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK War CONTENTs IDoc c? MAJOR 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 g ip MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 I-`e MONITORING RECORDS MAINTAINED 15 16 _ ACCESS CASING SECURED 17 18 PIPING 1g 20 INVENTORY RECONCIUATION 21 22 TANK GAUGING 23 24 PROVED RESPONSE PLAN 25 26 — UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED E 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: 57 58 NO 59 VIOL R ❑ VIOLO.R ❑ VIOL❑ OFFICE: INSP�yD , J ECEIVED BY: TITLESEM Dr RE H S PHONE: RECK: HUT-3 While-Original Yellow-Owner's Copy Pink-File Copy 5/ee OO .