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UNDERGRO" q NK PROGRAM OFFICIAL INSN REPORT N JOAQUIN HEALTH DISTRI( 1601 E. HAZELTON AVE. STOCKTON, CA 95205 CUUNTT ' COUNTY NAIVE - PHONE NO, 468-3423 SITE NAME: g./} 1 N G INSPECTION DATE: 3-/6 SITE ADDRESS: 17 . .�` _' .c��N(� CITY/STATE/ZIP 570G�/ A CHANGES SITE/OWNER/ PERMIT? YES NO TANK TANK 2 TANK - TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER �7 COMPUTER COMPUTER TYPE O II215PECTION SITE COMPUTER.# NUMBER /D/(� NUMBER[D 00 '� NUMBER NUMBER PER # PER # � '% PER # PER # N� 56 EXP. DATE DI � el EXP. DATO I ' EXP. DATE - EXP. DATE OPERATIONAL TANK TANK CON NM MtOfl MINOR PERMIT TO OPERATE - 1 2 4 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 CONDITIONS ABATED - 37 7777777 TEMPORARY TANK CLOSURE s REMOVAL OF RESIDUAL 38 139 _ - 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 THE MARKED ITEMS REPRESENT VIOLATI D MUST BE CORRECTED AS SYSTEM STATUS (MUST MARK FOLLOWS 1 &4� 1 �j uSC1 � L MAJOR VIOL ® MINOR VIOL ,AJC bk4z�p afJ r �� - (5 Go GTD I,5 'LNiPz 1 7 ' S 5 sats e Z e ,a ✓ t� o OFFICE: INSP:� RECEIVE Z,,jL j <!6�' b33� TITLE: rJ � ac PHON : RECK 4� 'l✓ i HUT-3 - ORIGINAL siva ©