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UNDERGRO"N' TANK PROGRAM OFFICIAL INF'r 'TION REPORT �aAN JOAQUIN HEALTH DISTRK,�, 1601 E. HAZELTON AVE. COUNTY NAME STOCKTON, CA 95205 COUNTY # PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER l� OMPUTER COMPUTER COMPUTER NUMBER /7 UMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# �,L PER# R# PER# / /a7 EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR ..:: �. n 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 u APPROVED MONITOR FREQUENCY 13 14 _ _.,....w.,_.. MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 — •- _..... PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 rr APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 - M _ APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 - - SAFETY HAZARD 35 36 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 144 45 �P�RMANENT TANK CLOSURE R 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 ....................... IMPROPER ABANDONMENT 55 56 T MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:W/X MAJOR 57 MINOR 58 NO 4a-so Olaf sz/k 59 C VIOL. ❑ VIOL. ❑ VIOL. C OFFICE: INSP: eR`�� OZ RECEIVED BY: TITLE: ''fZ5 PHONE: BECK: HUT-3 OWNER'S COPY 5/88 �"'