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UNDERGROU ANK PROGRAM OFFICIAL INSPION <br />REPORT <br />7' <br />REMOVAL OF RESIDUAL <br />AN JOAQUIN HEALTH DISTRICT* <br />FLAMMABLE VAPORS REMOVED <br />-� <br />ME <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br /># <br />j <br />COUNTY NAME <br />NO. 468-3423 <br />COUNTY <br />OWNER/OPERATOR MONITORING <br />44 <br />PHONE <br />56 <br />)YSTEM STATUS (MUST MARK ONE) <br />SITE NAME: Ig I< 5 <br />�. �� � <br />INSPECTION DATE: Y S) <br />59 <br />SITE ADDRESS:/ <br />®,s/��d%ITY/STATE/ZIP 147 <br />NO <br />VIOL. ❑ <br />CHANGES SITE/OWNER/PER/MIT? YES NO ANK TANK 2 <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTE <br />COMPUTE <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # PER # PER # <br />� <br />PER # <br />PER # <br />G <br />EXP. -DATE EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MA OR MINOR <br />USA <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />11 12 <br />MONITORING SYSTEM <br />13 14 <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />17 18 <br />ACCESS CASING SECURED <br />19 20 <br />PIPING <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />_a _ <br />31 32 <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />/ <br />TEMPORARY TANK CLOSURE <br />46 <br />47 <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ME <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />SAMPLING <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />e 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />mi <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />)YSTEM STATUS (MUST MARK ONE) <br />57 58 <br />59 <br />MAJOR MINOR <br />VIOL. VIOL. ❑ <br />NO <br />VIOL. ❑ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: sc= — ,ot lz <br />oa <br />OFFICE: INSP: RECE <br />TITLE: PHO If. RECK: <br />HUT -3 ORIGINAL <br />5/88 © t <br />