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/- /�X% UNDERGROU AN ION REPORT N JOAQUIN HEOFFICIAL DISTRICT �', 2 1601 E. HAZELTON AVE. STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-33423 SITE NAME: Y7 j;eA7pll/ � INSPECTION DATE: ^ 3 SITE ADDRESS: :�GfJ� CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER, COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER # (/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANKCONTENTS MI Nn 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 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED F37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 FLAMMABLE VAPORS REMOVED --------- ACCESS LOCATIONS SEALED -. -.- ----._.._.—.---. ---------- POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS I -- PIPING -. ----. ----. FLAMMABLE VAPORS REMOVED _. ---- ----UNAUTHORIZED RELEASE SAMPLING IMPROPER ABANDONMENT - THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 541- 5 Antr MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL. ^ ' via OFFICE: INSP:jV,,,, RECEIVED BY: TITLE: g.-S, PHONE: BECK: 5/88 ©M HUT-3 ORIGINAL