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UNDERGROIW TANK PROGRAM OFFICIAL INS CTiON REPORT SAN JOAQUIN HEALTH DISTRIC 1601 E. HAZELTON AVE. COUNTY NAME STOCKPHONE TNO. 468ON, CA 93423 COUNTY # SITE NAME: r /w uINSPECTION DATE: S�3iY��/ SITE ADDRESS: CITY/STATE/ZIP /j /6 l7 7 S. <�G �C..j% 4Cc7l7✓Cl CHANGES SITE YES NO TAN TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER .E' trfi:� PER# PER# PER # PER # OPERATIONAL TANK L, TANK coNreNrs EXP.DATE EXP.DATE EXP.DATE EXP.DATE MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 _ APPROVED CONSTRUCTION 5 ___,,.. WRITTEN MONITORING PROCEDURES 7 --- APPROVED MONITORING SYSTEM 9 10 _ MONITORING SYSTEM 11 t + 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 ... 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 _--- MANENT TANK CLOSURE REMOVA LS 46 47 PIPING 48 49 ..�_ w FLAMMABLE VAPORS REMOVED 50 _ UNAUTHORIZED RELEASE 51 52 C _ SAMPUNG 53 54 IMPROPER ABANDONMENT 55 56 SYSTEM STATUS(MUST MARK ONLY THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: c MAJOR 57 MINOR 58 VIO VIOL. 59 NO❑ VIOL. ❑ OFFICE: INSP: � RECEIVED BY: TITLE: PHONE: BECK: rluT-3 ORIGINAL siaa O�