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UNDERGROUTANK PROGRAM OFFICIAL INSPTION REPORT VAN JOAQUIN HEALTH DISTRICT ._ 1601 E. HAZELTON AVE. q STOCKTON, CA 95205 COUNTY # 1 COUNTY NAMEN PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: / V z0 SITE ADDRESS: /� CITY/STATE/ZIP 5)dr frN. �StS or " Ca CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# yN / C7 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK coNreNTs MAJOR MYNOiR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 - ---' 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 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 38 39 FLAMMABLE VAPORS REMOVED 4D _ - ACCESS LOCATIONS SEALED 41 42 — -- POWER DISCONNECTED - -- -- OWNER/OPERATOR MONITORING Mi5 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: 57 MAJOR MINOR 58 NO VIOL. VIOL. VIOL. OFFICE.: INSP: �/ RECEIVED BY: TITLE: 1"-2- PHONE: BECK: �iaa O HUT-3 ORIGINAL