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UNDERGROt "" TANK PROGRAM OFFICIAL INSP� TION REPORT SAN JOAQUIN HEALTH DISTRIC M 1601 E. HAZELTON AVE. STOCKTON, CA 5206 COUNTY NAME PHONE NO. 468-93423 COUNTY # SITE NAME: IWL2� � Po INSPECTION DATE: 401a 9 SITE ADDRESS: �� CITY/STATE/ZIP � 4A� s CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM RAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSP�ECTION SITE COMPUTER # PER # j Ij O ' D I PER # (t 5 a � # PER # EXP. DATE - EXP. DATE EXP. DATE EXP. DATE TANK OPERATIONAL TANK RMINOR MAJOR MCONTENTS R 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 P ACCESS CASING SECURED 17 18 - PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 127 128 - SAMPLING E37 -- APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED --- -- SAFETY HAZARD ----- CONDITIONS ABATED TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 - - FLAMMABLE VAPORS REMOVED 40 ---- ACCESS LOCATIONS SEALED 41 42 - - POWER DISCONNECTED 43 _ -- - I OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS IkTHE - ------ -_ — - - _ - - - r PIPING FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE SAMP I ROPER ABANDONMENT ED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM ARK ONE) FOLIOVyS «-� - MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. VIOL. ❑ OFFICE: INSP: /f / RECEIVED BY: / TITLE: �l�s PHONE: PECK: stea C ui ir_a - ORIGINAL