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UNDERGROI.f TANK PROGRAMA OFFICIAL INS TION REPORT SAN JOAQUIN HEALTH DISTRIC 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: _ / J INSPECTION DATE: a SITE ADDRESS: CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES Nd_7 TANK TANK TANK TANK FORM AAND/OR F3 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER ,f �/ NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER # I5 PER IPER # PER # EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS M12 PERMIT TO OPERATE CHANGE IN CONDITIONS TO OP€RATE APPRQVED CONSTRUCTION .__ WRITTEN MONITORING PROCEDURES 7 8 - APPROVED MONITORING SYSTEM 9 ' 10 MONITORING SYSTEM 11 12 - -- -- APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15A 116 _.. - - — 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 35 36 -- — CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 - FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 - POWER DISCONNECTED m 43 OWNER/OPERATOR MONITORING 144 145 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 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL. LJ VIOL. VIOL.❑ OFFICE: INSP: C_� RECEIVED BY: l TITLE: 1`1`�� r' PHONE: HECK: HUT-3 FILE COPY eras p+