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UNDERGROUII&TANK PROGRAM OFFICIAL INSPISION REPORT SAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. Q STOCKTON, CA 95205 COUNTY # 1 COUNTY NAME PHONE NO. 468-3423 SITE NAME: � pelk I`O S INSPECTION DATE: l 111e� 6 SITE ADDRESS: 5 n'�(�c� F 5+ CITY/STATE/ZIP Z44-- V-\ q`� ;?-075 CHANGES SITE YES NO TANK TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTTE'p PER # PER# PER # PER # EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK CONTENTS OPERATIONAL TANK 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 a 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 ---- ---�- FLAMMABLE VAPORS REMOVED 50 -- ---- UNAUTHORIZED RELEASE 51 52 --- -- SAMPLING 53 54 -""- - IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED QS, - •_'^ SYSTEM STATUS(MUST MARK ONE) FOLLOWS: « Irel UKA P2 u f t Cfirn -La MAJOR 57 MINOR 58 NO 59 d11 11 VIOL. ❑ VIOL. ❑ VIOL. OFFICE: INSP:/1 RECEIVED BY: TITLE:�115p� `�a_r— PHONE: RECK: siaa O M HUT-3 ORIGINAL