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4 UNDERGROUI&TANK PROGRAM OFFICIAL INSP TION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 RN PHONE NO. 468-3423 COUNTY # SITE NAME: �R4ntZlk :13ROV4EEln _ INSPECTION DATE: SITE ADDRESS: � O L 1 IN CITY/STATE/ZIP FI FOS CHANGES SITE/OWNER/PERMIT? YES NO TANK Ig4LO-O TANK TANK I )q`4b-DZ TANK �q4b-� TANK FORM AAND/OR B SUBMITTED? 173 COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER �U NUMBER NUMBER3,r NUMBER ''^^ PER# PER# //{J��ju PER#Z -- PER # E lt! EXP.DATE/eS EXP.DATE r' EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONMNTS 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 SYSTEM11 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 35 36 --- -- "---"-- -- --- CONDITIONS ABATED37 ------ - ---- -- -- ---- v. TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 89 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 ,a PIPING 48 49 - FLAMMABLE VAPORS REMOVED 50 ---- "------- UNAUTHORIZED RELEASE 51 52 ---- ----__.-...`-- SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 -" "--- --'------ - - SYSTEM STATUS(MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: MAJOR 57 MINOR 58 NO 59 st VIOL ❑ VIOL ❑ VIOL OFFICE: INSP: Tiler RECEIVED BY: TITLE: PHONE: RECK: HUT-3 ORIGINAL 5/88 OM