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AGROUND TANK OFFICIAL INSPECTION ART <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 38B <br /> COUNTY NAME ��,�J��� Stockton,6CA <br /> 3aioot-g3e6 COUNTY # <br /> SITE NAME: 5t INSP'ECTION DATE: ,5 J <br /> SITE ADDRESS: CITY/STATE/ZIP , cam; L f7 <br /> A), v '6 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP DATF <br /> OPERATIONAL TA K TANK CONTENTS ©) �. <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 _ <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 135 136 / <br /> CONDITIONS ABATED 37 ✓ <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43! <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED _ <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOOWS: e— S c W I +L 30 Wasst <br /> MAJOR 57 MINOR 58 NO 55999 r <br /> VIOL. L] VIOL. ❑ VIOL.IJ <br /> _ I <br /> OFFICE: INSP -r RECE Y: <br /> TITLE:SpiV I op, REM PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/se am <br />