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UNDERGROUND JPROGRAM OFFICIAL OAQUIN HEALTH DISTRICT ECTTV REPORT 1601 E. HAZELTON AVE. ** STOCKTON, CA 95205 COUNTY # 31 COUNTY NAME PHONE NO. 468-3423 SITE NAME: G� 2 fjSS O nJ T/ C,�Q l LLAc, �MGNSPECTION DATE: SITE ADDRESS: Z7 5-0 �Cjsf �2P CITY/STATE/ZIP ctds- CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TAN TANK FORM AAND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER NUMBER/000 NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER # A14- PER# PER# PER # �O`LJ77✓� j! EXP.DATE �s EXP.DATE EXP_DATE EXP.DATE OPERATIONAL TANK TA OR MINOR IN R 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 lf 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 28 - UNAUTHORIZED RELEASE OCCURRENCE 27 28 - SAMPLING 29 30 _ -- APPROVED TANK REPAIRS 31 32 _ _ -- -_--------- UNAUTHORIZED RELEASES REPORTED -..-- SAFETY HAZARD - ---- - CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED M Z _ OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 - PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 .._. ---------- UNAUTHORIZED RELHASE 51 52 ----------- SAMPLING 5354 IMPROPER ABANDONMENT 55 56 TH_E MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOULLIOYW/S:_ NOT #N L45 e-. S - V MAJOR57 MINOR 58 NO 59 VIOL VIOL. ❑ VIOL.❑ L r l OFFICE: INSP: ,� RECEI- BY TITLE: e ��' PHO\(N/E�: BECK: 20-e �=3 w HUT-3 ORIGINAL