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UNDERGROUV TANK PROGRAM OFFICIAL INSPF"TION REPORT <br />,,.,SAN JOAQUIN HEALTH DISTRICT 4, <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # i <br />COUNTY NAME PHOMP Nn ARA -q492 i <br />SITE NAME:INSPECTION <br />DATE: 2 �CJ <br />E <br />� ioAl-4L <br />SITE ADDRESS: Z3 SDd <br />�\ /ESSOn/ %Z c( CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK b TANK F"L TANK c;?, TANK Q <br />JJ COMPUTER COMPUTEe� <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />NUMBER <br />NUMBER NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMP/UT�EER <br />PER # PER # PER # PER # <br />/# <br />6 J ` <br />EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANKcoNreNrs <br />r& <br />MAJOR NINOR <br />- <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 118 <br />PIPING <br />19 J20 <br />INVENTORY RECONCILIATION <br />21 122 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 126 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />V11, 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />I38 139 <br />_ <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 r45 <br />_ <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORAS� <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOW' <br />=X::� <br />57 58 <br />59 <br />"= <br />MAJOR MINOR NO <br />❑ ❑ <br />tt Lg <br />VIOL. VIOL. VIOLzvptl <br />OFFICE: <br />INSP: G./ <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />RECK: <br />NUT -3 ORIGINAL 5/W uM <br />