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UNDERGROU ANK PROGRAM OFFICIAL INSP ION REPORT 'MAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # QvL PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: /p Z SITE ADDRESS: o 15- /va t (/� CITY/STATE/ZIP 6z&la SITE/OWNER/PERMIT? S NO TANK TANK ® ' TANK TANK FORMA ND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE—O INSPELCTION/� SITE CSOYPUTE PER# PER# PER# PER# 7[ / ?�lYI'C_ /L.�O EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TMKCONn NTS 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 MONITORING SYSTEM 11 12 -- APPROVED MONITOR FREQUENCY 13 14 1 -- MONITORING RECORDS MAINTAINED 15 16 __.. .. ACCESS CASING SECURED 17 18 PIPING 19 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 -- UNAUTHORIZEDRELEASESREPORTED 33 34 -- SAFETY HAZARD 35 36 s _ _.. �_ . .. . _. ... _-.. ._.-. CONDITIONS ABATED TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 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 E CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: kau n m IAA" ZI`�� MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL OFFICE: INSP: ldZ14 RECEIVED - - TITLE: PHONE: BECK: siee HUT-3 ORIGINAL ©