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UNDERGROU"'O T1NK PROGRAM OFFICIAL INSP"CT'ON REPORT E ,N JOAQUIN HEALTH DISTRIC'' "mope E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: 9l4/ SITE ADDRESS: CITY/STATE/ZIP Ile.� IFS c e, lcrr CHANGES SITE/OWNER/PERMIT? YES NO OfANN K TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPEQF INSPECTION SITE COMPUTER# -5 o0 / 5?.- /� PER# -PER# PER# PER# � p� !S Z) EXP.DATE' EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TAN TANK CON'MNTs MAJOR MINOR 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 28 _ SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 _ CONDITIONS ABATED FA7737 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 _ FLAMMABLE VAPORS REMOVED — ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 _ PERMANENT TANK CLOSU _n REMOVA AL MATERI S�'W 46 147 PIPIN 48 49 FLAMMABLE VAPOR MOVED t/ O< 50 UNAUTHORIZED LEASE 51 52 _ SAMPLING W19L 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: i!Ce 57 58 59 MAJOR MINOR NO ' VIOL. ❑ VIOL. ❑ VIOL. S OFFICE: INSP: � RECEIVED BY: TITLE: PHONE: BECK: HUT-3 ORIGINAL siaa G,.