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UNDERGROUN NK PROGRAM OFFICIAL INSPESON REPORT AN JOAQUIN HEALTH DISTRICT 1601-E. HAZELTON AVE. STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-3423 SITE NAME: G��eS ruGK� INSPECTION DATE: SITE ADDRESS: 3G31 CITY/STATE/ZIP STA)7 C CHANGES--SITE/OWNER/PERMIT? YES NO TANK Q ( TANK Q 3 TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER # PER # re m o-v&'L 1703 EXP.DATE EXP DATE EXP DATE EXP.DATE OPERATIONAL TANK TANK coNTENT 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 26 -- SAMPUNG 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 40 ------ ACCESS _ACCESS LOCATIONS SEALED 41 42 -- POWER DISCONNECTED 43 _ OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS uc PIPING FLAMMABLE VAPORS REMOVED URIZEDRELEAS ?!pitaSA I ��IMPROPER ABANDONMENT THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 56 59 MAJOR NO VIOL. ❑ ' VIOLL..R ❑ VOL❑ - OFFICE: INSP: RECEIVED BY: TITLE: PHONE: BECK: siaa O� HUT-3 ORIGINAL