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UNDERGROSP TANK PROGRAM OFFICIAL IN CTION REPORT SAN JOAQUIN HEALTH DISTRI 1601 E. HAZELTON AVE. COUNTY NAME STOCK205 PHONE TNO. 468-ON, CA 3423 COUNTY # SITE NAME: 1-17' -0 ,--T INSPECTION DATE: �7 SITE ADDRESS: GOp�CYC CITY/STATE/ZIPP,'�� 9SZ sld CHANGES SITE/OWNER/PERMIT? YES NO TANK 4L/ TANK zZ TANK e TANK FORM A AND/OR B SUBMITTED? COMPUTER/'a o COMPUTER/0i44P COMPUTER COMPUTER NUMBER ti/G NUMBER 4�L NUMBER /��o NUMBER TYPE OF INSPECTION SITE COMPUTER# - ®� PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL 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 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 CONDITIONS ABATED TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W444t5 -- 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 52 - -"- SAMPLING f3 54 - -- " IMPROPER ABANDONMENT 55 56 - THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: f MAJOR 5 MINOR 58 NO 59 VIOL. VIOL ❑ VIOL.❑ OFFICE: INSP: � RECEIVED BY TITLE_ �•�. /7 ' PHONE. RECK: HUT-3 ORIGINAL siea &