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UNDERGROUfb TANK PROGRAM OFFICIAL INSTION REPORT SAN JOAQUIN HEALTH DISTRICW 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # 39 G/N PHONE NO. 468-3423 SITE NAME: $ INSPECTION DATE: 8/Zyl�� SITE ADDRESS: CITY/STATE/ZIP �o Loi Sfik IQ CA r1S.20S- CHANGES SITE/OWNER/PERMIT. YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? PS COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER i-- PER# PER# PER# PER# S 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 RELEASE OCCURRENCE 27 28 ' SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 - - UNAUTHORIZED RE6EASES 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 52 SAMPLING 53 54 " IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) / Nb FOLLOWS n C�SPr / Jyc "" 58 gem,` gem, 59 MAjQR MINOR NO .VIOL. ❑ VIOL ❑ ❑ VIOL I ku OF E; INSP: , /GN� RECEIVED BY: TITLE: CN S PHONE: BECK: HUT-3 OWNER'S COPY 5/88 OM