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UNDERGROUM TANK PROGRAM OFFICIAL INS SAN JOAQUIN HEALTH DISTRICP TION REPORT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 Ttl �/�/� PHONE NO. 468-3423 COUNTY # 3 9 SITE NAME: SAO _ l Y1 fi C CY!W Q ?,(1 ori INSPECTION DATE: Ma /:5 1C SITE ADDRESS: L/ r u6 Y, n) , /' /�� CITY/STATE/ZIP / CHANGES SITE/OWNER/PERMIT? YES NO TANK TA 6 TANK Nle (j Z NK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER 1 /) •� PER# PER# PER# PER# EXP DATE EXP_DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK coNleNrs MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 - APPROVED CONSTRUCTION 5 6 - - -- WRITTENMONITORINGPROCEDURES 7 8 - -- APPROVED MONITORING SYSTEM 9 10 -- - - --MONITORINGSYSTEM11 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 - - SAMPLING29 30 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 48 49 i---- FLAMMABLE VAPORS REMOVED --`------ UNAUTHORIZED RELEASE 51 52 - -'------ SAMPLING 53 54 - ..._____...____._ IMPROPER ABANDONMENT 55 56 - SYSTEM STATUS(MUST MARK ONE) -- THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: 57 58 59 v 0 OL MAJOR MINO❑ VIOL NO❑ VOL.❑ OFFICE: INSP: RECEIVED BY: TITLE: �YU PHONE: BECK: 'kb HUT-3 ORIISINAL 5/88 em