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UNDERGROUIS TANK PROGRAM OFFICIAL INSP- TION REPORT SAN JOAQUIN HEALTH DISTRIC mW 1601 E. HAZELTON AVE. COUNTY NAME PHONE STOCKTONO. 48-34©3 COUNTY # SITE NAME: INSPECTION DATE: �/ CITY/STATE/ZIP SITE ADDRESS: e,.-,/ • /tsN G'9 CHANGES SITE/OWNER/PERMIT? YES NO TANK -7- TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION FSITECOMPUTER# PER# PER # PER # PER# C- ISO I EXP.DATE EXP-DATE EXP.DATF EXP.DATE ex OPERATIONAL TANKTANK CONTENTS / MAJOR MINOR 7G 3C' PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 __�_ _ __ — ••, - APPROVED CONSTRUCTION 5 6 -- WRITTEN MONITORING PROCEDURES 7 1 8 --- APPROVED MONITORING SYSTEM 9 14 -- ------- MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 -- - MONITORING RECORDS MAINTAINED 15 16 _.._ ACCESS CASING SECURED 17 18 PIPING 19 120 w INVENTORY RECONCILIATION 21 122 TANK GAUGING 23 124 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 LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING L44 45 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. VIOL. VIOL. OFFICE: INSP: - RECEIVED BY: /A TITLE: P O E: RECK: • eras HUT-3 ORIGINAL