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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT WSAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 PHONE NO, 468-3423 COUNTY # SITE NAME: Y% / / O� l_ �v/ INSPECTION DATE: SITE ADDRESS: G 2 y / CITY/STATE/ZIP CHANGES SITE YES NO TANK TANK 7— TANK 3 TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE O INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER / c, PER# PER# PER# PER# O4, tiA[ / Y S / EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANKcoN -NTS MAJOR MINOR DOO ©O(J 6�..62r�' PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 - "- --- - APPROVED MONITORING SYSTEM g 10 " --- MONITORING SYSTEM 11 12 - -- APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 --- ACCESS CASING SECURED 17 18 -- �- ---- PIPING 19 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 - - UNAUTHORIZED RELEASE OCCURRENCE 27 28 - - SAMPLING 29 - APPROVED TANK REPAIRS 31 32 - UNAUTHORIZED RELEASES REPORTED 33 34 ------ SAFETY HAZARD 35 36 CONDITIONS ABATED 37 - " --- TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 -- ACCESS LOCATIONS SEALED 41 42 ------- POWER DISCONNECTED43 OWNER/OPERATOR MONITORING 44 45 ' PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 49 FLAMMABLE VAPORS REMOVED -- UNAUTHORIZED RELEASE 51 52 ""- SAMPLING 53 54 - - IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESEN�j[VIOLATIONS AND MUST BE CORRECTE AS SYSTEM STATUS(MUST MARK ONE) FOLLOW ,- //✓� ,,l Gyjj�TI j J G MAJOR 57 58 59 MINOR NO SV /�� O4 V erg fes- D '� VIOL VIOL. VIOL a— - r73 9 f' .S•J mf �� A OFFICE: INSP: _ RECEIV D BY: TITLE: � PHONE: BECK: HUT-3 ORIGINAL 5/88 OM