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UNDERGROUND TANK OFFICIAL INSPECTION RLQ-dRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMEENTWALbeHEALhTM DIVISION <br /> Rr <br /> Mailing Addral P.O.Boz 388 <br /> COUNTY NAME Stmkton,CA 95201-0388 COUNTY # <br /> 48&3420 <br /> SITE NAME: al 09 (Z 3 INSPECTION DATE: <br /> SITE ADDRESS: /03y �. yr CITY/STATE/ZIP w <br /> CHANGES SITE/OWNERI/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER �� COMPUTER ��2 COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TY F INSPECTION SITE COMPUTER• PER 0 PER 0 PER A PER R <br /> /L.. EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> /111!1(CON1EN19 ' '': i C,7P j' 1 <br /> OPERATIONAL TANK / 4 <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 SYS]EM 9 IO <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 IB <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 _ <br /> TANK GAUGING E30 <br /> APPROVED RESPONSE PLAN <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY IIAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE ' <br /> REMOVAL OF RESIDUAL pt43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE M" <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 A9 <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(JUST BE CORRECTED AS <br /> SYSTEM STATUS(MUS1 MARK ONE) FOLLOWS:------- <br /> 57 <br /> OLLOWS: —57 50 59 --_--_._-- <br /> VIO-R LJVIOLR ❑ VIOL.❑ <br /> OFFICE: INSP: 4LtRECEI D BY: <br /> TITLE: ? : HECK: <br /> I IUT-3 While-Orlalnal Yellow-Owner'e CoPY Fink File CoPv <br /> PHS 178 (4/96) <br />