SITE INFORMATION AND CORRESPONDENCE

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UNDERGROU' --) TANK PROGRAM OFFICIAL INSP--MON REPORT SAN JOAQUIN HEALTH DISTRI 1601 E. HAZELTON AVE. COUNTY NAME SQyt�Q STOCKT6 8-3423 95205 NO. 4 PHONE NO. 46COUNTY # SITE NAME: INSPECTION DATE: /I /7 SITE ADDRESS: CITY/STATE/ZIPS! /e4,/ q 5";t,0-5- CHANGES a4-5-CHANGES SITE/OWNER/PERMI ? YES NO TAN 0 { TANK Q TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER f S g NUMBER 15g]� NUMBER NUMBER lar PER# PER # PER # PER# �C•C~ D EXP.DATE EXP,DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 g 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 19 120 ' INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 132 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 136 _ CONDITIONS ABATED 37 - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 �i9 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 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) FOLLOWSw � MAJOR 57 MINOR 58 NO 59 {JJ VIOL. VIOL. ❑ VIOL.❑ OFFICE: INSP: RECEIVED BY: TITLE: PHONE: BECK: HUT--3 ORIGINAL a'