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UNDERGROF"'1 TANK PROGRAM OFFICIAL IN �_ ^TION REPORT SAN JOAQUIN,HEALTH DISTRI 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 `COUNTY PHONE NO. 468-3423 f SITE NAME: v I INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIPS CHANGES SITE/OWNER/PERMIT? YES N7NUMBER ; r TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER PER# PER# PER # EXP.DATE„ EXP DATE EXP DATE EXP DATE OPERATIONAL TANK TANK CONTENTS0kf. MAJOR MINOR `-`.. r - "5`_ s`' '(s',+'•". ,.. FNr, .t,� 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 W — ACCESS CASING SECURED 17 18 PIPING 19 20 -- —� 1 INVENTORY RECONCILIATION 21 22 r TANK GAUGING 23 24 -- APPROVED RESPONSE PLAN 25 26 --- -- — — ---- UNAUTHORIZED RELEASE OCCURRENCE 27 28 '—`— i SAMPLING 29 30 - ---- APPROVED TANK REPAIRS 31 32 _— UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED M37 . - -- TEMPORARY TANK CLOSURE y REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED _— ACCESS LOCATIONS SEALED 41 42 —_s_.._ POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 i ERMANENT TANK CLOSURE ` ;, � - r � : RZ 46 47 PIPING 48 49 — FLAMMABLE VAPORS REMOVED — UNAUTHORIZED RELEASE 51 52 � SAMPLING 53 54 — - - ---- .--- IMPROPER ABANDONMENT 55THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) 4 FOLLOWS: !MAJO ^ d I57 58 69 NO VIOL. ❑ VIOLOR ❑ VOL❑ f OFFICE: IN SP. RECEIVED.BY: TITLE: �.C S PHONE: BECK: HUT-3 ORIGINAL