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UNDERGROUMTANK PROGRAMA OFFICIAL INSPTION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME /4q/ //+� STOCKTON, CA 95205 '�� " C.' PHONE NO. 468-3423 COUNTY #3 SITE NAME: (�,L'41721L 1� INSPECTION DATE: " ! SITE ADDRESS: � `, y' r CITY/STATE/ZIP S C4 CHANGES SITE/OWNER/PERMIT? YES NO TAN LK�" TANK ' TANK ' 7 TANK FORM A AND/OR B SUBMITTED? COM ER 4 COMPU R COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBI R NUMBER NUMBER NUMBER PER# PER# PER# PER# rQ + `"" � 3 EXP.DATE EXP.DATE EXP.DATE EXP DATE OPERATIONAL TANK TANKcor�TeNTs MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 v/ PROVED CONSTRUCTION 5 g -- WRITTEN MONITORING PROCEDURES 7-7 8 " APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM -- 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED !21 16 ACCESS CASING SECURED 18 PIPING 20 INVENTORY RECONCILIATION 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 mm...� SAFETY HAZARD 35 36 CONDITIONS ABATED 37 - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 442 :7� FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 49 PERMANENT 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 SYSTEM STATUS{MIDST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL. VIOL. ❑ VIOL.❑ OFFICE: INS P" RECEIVED BY: TITLE 18`L /_R ff}� PHONE: RECK: HUT-3 ORIGINAL 5/88 Q