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' UNDERGROUIt,^ '-NNK PROGRAM OFFICIAL INSPF.7sON REPORT ? O ) !„�N JOAQUIN HEALTH DISTRICT- w- 1601 E. HAZELTON AVE. STOCKTON, CA 95205 CoONTY # J 9 Y NAME PHONE NO. 468-3423 INSPECTION DATE: E NAME- rn v � YL , SITE ADDRESS: Sfid LN 5T CITY/STATE/ZIP S�aG Uy� G�V CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER 0 COMPO { COMPUTER COMPUTER NUMBER/ � NUMBS rp�G(+�� NUMBE�rt/1/> NUMBER TYPE OF I PECTION SITE COMPUTER# PER# r �'Sf PER# p 1 PER # PER# U 2 EXP.DATE 1! EXP.DATE ' EXP DATE ' � P.DATE OPERATIONAL TANK TANK CONTE MAJOR MINOR ' w ' 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 2B SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 -- SAFETY HAZARD 35 36 - CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE i REMOVAL OF RESIDUAL 38 --- FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 - POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING `8 `9 FLAMMABLE VAPORS REMOVED 50 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) FOLLOWS: 58 9 MAJOR 57 MINOR NO FVI VIOL. ❑ VIOL ❑ VIOL OFFICE: INSP: /�f RECEIVED BY: L � a / TITLE- PHONE: BECK: HUT-3 ORIGINAL