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> - r UNDERGRO►- TANK PROGRAM OFFICIAL INS �'`�TION REPORT k Y ,USAN JOAQUIN HEALTH DISTRIC j 1501 E. HAZELTON AVE. : STOCKTON, CA 95205 COUNTY # COUNTY NAME PHONE NO. 468-3423 , SITE NAME: Gam, INSPECTION DATE: 1� SITE ADDRESS: CITY/STATE/ZIP O t/6� i- CHANGES SITE/OWNER/PERMIT?(_YES NO TANK TANK TANK TANK FORM AAND/OR B SIjBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER I NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# I J EXP.DATE EXP.DATE EXP.DATE is EXP.DATE OPERATIONAL TANK TANK CONTENTS 0' MAJOR I MINOR _ '� r: �� 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 _ ACCESS CASING SECURED 17 18 -- — �— PIPING 19 20 INVENTORY RECONCIUATION 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 i CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38. 39 -- FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 —.._._- ......... OWNER/OPERATOR MONITORING 44 45 . J V PERMANENT TANK CLOSURE ; ` REMOVAL OF RESIDUAL MATERIALS 46 147 PIPING 48 149 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 i SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS IMUSF MARK ONE) FOLLOWS: "57 59 MAJOR MINOR 56 NO VIOL. ❑ VIOL. ❑ VIOL.❑ OFFICE: INSP: RECEIVED BY: TITLE: PHONE: FRECK- HUT-3 ORIGINAL 5/B8�om