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ANK PROGRAM OFFICIAL INSPWION ' UNDERGROUI+�TAN JOAQUIN HEALTH D STRICTW REPORT �� 1601 E. HAZELTON AVE STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-3423 SITE NAME: / INSPECTION DATE: !/- h9uitGY biz Le SITE ADDRESS: /lJ��so� �� CITY/STATE/ZIP �� CHANGES SITE/OWNER/PERMIT? YES NO T K TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER#a y3k-OX PER# )V38-07i PER# �sl3PER # !� ��-17.x`s )N �O EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANKCONTENTS MINOR IN R MAJOR MINOR �� 2 - �_.. PERMIT TO OPERATE CHANGE IN CONDITIONS TO OPERATE 3 4 S APPROVED CONSTRUCTION 5 6 L e -- - WRITTENMONITORINGPROCEDURES 7 8 - _ -- APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 -- APPROVED MONITOR FREQUENCY 13 14 - MONITORINGRECORDSMAINTAINED 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 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL P44t7- PERMANENT FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWERDISCONNECTED OWNER/OPERATOR MONITORING TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 _- .-_ -- -- -- -- PIPING 48 49 -- 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: 57 r MAJOR MINOR 58 NO 59 O VIOL- MINOR ❑ VIOL. OFFICE: INSP: �Z p l Oz-- RECEIVED BY: TITLE: ei 6/ 5 PHONE: BECK: 5iss Ou HUT-3 ORIGINAL