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UNDERGROU TANK PROGRAM OFFICIAL JOAQUIN HEALTH D SCT TRIfTION REPORT 1601 E. HAZELTON AVE. COUNTY # STOCKTON, CA 95205 COUNTY NAME N PHONE NO. 468-3423 INSPECTION DATE: A �� SITE NAME: a 6 �/' SITE ADDRESS: CITY/STATE/ZIP 503(- 00 S. CHANGES SITE/OWNER/PERMIT. NO TANK ( TANK TANK 3 COMP TANK COMPUTER COMPUTER COMPUTER FORM A AND/OR B SUBMITTED? �aS NUMBER E� NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE ^, TANK CONTENTS OPERATIONAL TANK 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 -- - UNAUTHORIZEDRELEASEOCCURRENCE 27 26 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 3a 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 - OWNER/OPERATOR MONITORING 44 45 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: 58 59 MAJOR 57 MINOR NO VOL.ElVIOL. VIOL. OFFICE: INSP:/>/ �S 1! N fi RECEIVED BY:`<- � x09- 9,4g7-y'wo TITLE: /pE//S PHONE: RECK: siea C HUT-3 ORIGINAL