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UNDERGROUN AN JOAQUIN HEALTH DISTRICT �ION REPORT �5 1601 E. HAZELTON AVESTOCKTON, CA 5205. COUNTY NAME PHONE NO. 468-93423 CUIINTY # SITE NAME: �0�� O / INSPECTION DATE: SITE ADDRESS: /5 // Ae<61- S CITY/STATE/ZIP �j✓ yS�ZC7� CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTNUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER # PER# PER # EXP.DATE EXP.DATE EXP DATE EXP DATE OPERATIONAL TANK TANK CON ENTS +' 777777 MAJOR MINOR ^" - -- -- . ' " PERMIT TO OPERATE 1 2 _- ------- - --- CHANGE IN CONDITIONS TO OPERATE 3 4 - APPROVED CONSTRUCTION 5 6 -- ---- - WRITTEN MONITORING PROCEDURES 7 8 --- APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 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 ----- SAMPLING 29 30 ` APPROVED TANK REPAIRS 31 32 .----- -- - UNAUTHORIZED RELEASES REPORTED 33 34 -- SAFETY HAZARD 35 36 CONDITIONS ABATED 37 OXA TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 _ -.------- ACCESS LOCATIONS SEALED 41 42 --,- -`-----"- POWER DISCONNECTED 43 -.. - --- - OWNER/OPERATOR MONITORING 44 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: TITLE: PHONE: BECK: siaa O� HUT-3 ORIGINAL