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UNDERGROW TANK PROGRAM OFFICIAL INS&TION REPORT SAN JOAQUIN HEALTH DISTRICIW 1601 E. HAZELTON AVE. COUNTY NAME i�C� STOCKTON, CA 95205 COUNTY # 9 PHONE NO. 468-3423 SITE NAME: INSPECTION DATE: 3-IC11 SITE ADDRESS: �G7�Z /)a 1� J��` �� CITY/STATE/ZIP C P CHANGES SITE/OWNER/PERMIT/? YE$ TANK ©l TANK 0-2_ TANK p3 TANK FORM A AND/OR B SUBMITTED? e'S q� COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER (Ulla NUMBER NUMBER TY E OF INSPECT ION. SITE COMPUTER# �o rj � �y�, PER# PER# e jo PER# PER# v EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIO AL TANK TANK CONTENTS. MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6WRITTEN MONITORING PROCEDURES 7 8 7-7r 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 w APPROVED RESPONSE PLAN 25 26 � UNAUTHORIZED RELEASE OCCURRENCE 27 28 m SAMPLING 29 30 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 44 45 m PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 � SAMPLING 53 54 IMPROPER ABANDONMENT 155 56 THE MARKED ITEMS REPRESENT VIOLATIQNS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 58 59 MAJOR MINOR NO VIOL. ❑ VIOL. ❑ VIOL. OFFICE: INSP: 9R�E/yC�EIVE�D�BY�: TITLE: �s _ PHONE: r � r HUT-3 ORIGINAL 5/88 0M