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UNDERGROUNWANK PROGRAM OFFICIAL INSP ION REPORT WSAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAMESc_, ¢ (ti, STOCKTON, CA 95205 G1 PHONE NO. 468-3423 COUNTY #._T7 SITE NAME: /--,t �, ! 0"ri INSPECTION DATE:Wl=� ' o SITE ADDRESS: CITY/STATE/ZIPStart l 1/ C,4Cres;�-6 1 CHANGES SITE/OWNER//PERMIT? YES NO TANK 6 / TANK 0 P__ TANK 0 TANK FORM A AND/OR B SUBMITTED? COMPUTEF2 COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER .R PER# PER# PER# PER# EXP.DATE EXP.DATE EXP-DATE EXP.DATE OPERATION L TANK TANK CONTENTS 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 3p - APPROVED TANK REPAIRS 31 32 - UNAUTHORIZED RELEASES REPORTED 33 34 \ "- SAFETY HAZARD 35 36 CONDITIONS ABATED 37 "- 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 46 47 PIPING qg qg FLAMMABLE VAPORS REMOVED 50 - UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 --._.__ ._...... IMPROPER ABANDONMENT 55 56 - -- THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR ❑58 NO 59 VIOL. VIOL. VIOL.❑ OFFICE: INSP: RECEIVED BY: TITLE: �� C..�S' PHONE: BECK: HUT-3 ORIGINAL siea ©,