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UNDERGROUNjjANK PROGRAM OFFICIAL INSPE ON REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVESTOCKTON, CA 5205 . 7 C COUNTY NAME PHONE NO. 4 893423 COUNTY # > j SITE NAME: 441e-"' / 5^0 INSPECTION DATE: j/7 2 SITE ADDRESS: Q� �/ L�� CITY/STATE/ZIP 7NUMBER� � �5�3 CHANGES SITE/OWNER/PERMIT? YES NO TANK I TANK 7i TANK FORM AAND/OR B SUBMITTED? COMPUTER I COMPUTER MPU COMPUTER NUMBE Q NUMBER U(C� d NUMBER TYPE OF SPE TION SITE COMPUTER# PER # DPER# ��"'�iyn PER# EXP.DATE EXP.DATeEXP.DATE OPERATIONAL TANK TANK R MI NOR MAJOR MINOR PERMIT TO OPERATE 1 2 ...._.._. _.. _._ .. _ _... . _... CHANGE IN CONDITIONS TO OPERATE 3 4 -_.. ._ - APPROVED CONSTRUCTION 5 6 _ ---- WRITTEN _WRITTEN MONITORING PROCEDURES 7 16 / / .. .. - APPROVED MONITORING SYSTEM 9 10 v _ _ I/ MONITORING SYSTEM 11 12 -- APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 16 -- PIPING 19 20 - - INVENTORY RECONCILIATION 21 22 .-- 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 W43 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 50 -- -------..--..-- UNAUTHORIZED RELEASE 51 5 / SAMPLING 53 4 VV tVt� IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS UST MARK ONE) FOLLOWS: MAJOR 7 MINOR 8 NO 59 VIOL VIOL ❑ VIOL-❑ OFFICE: INSP- / RECEI' n TITLE:4450/15 PHONE: GGii//�� 5/88 ©M HUT-3 ORIGINAL