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UhmeRGROUND TANK OFFICIAL INSPECTION RL�RT SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street Mailing Address: P.O.Box 388 COUNTY NAME Stockton,CA 95201-0388 488-3420 COUNTY # (� SITE NAME: uh0.b I C 'moo \ / 7} INSPECTION DATE: SITEADDRESS: �� sem. Comma �O1 o�u R(� CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK ! TANK TANK TANKG FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER G PER# PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR -, r PERMIT TO OPERATE 1 2 •/ CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 c1J cJ 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 RECONCILIATION 21 22 ANK GAUGING 23 2q APPROVED RESPONSE PLAN 25 _. 28 / UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 2g 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 _ - --- CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE x REMOVAL OF RESIDUAL 38 39 / FLAMMABLE VAPORS REMOVED 40 �i j ACCESS LOCATIONS SEALED 41 42 4/ POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 __ / ✓ PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 ✓ ✓ _ UNAUTHORIZED RELEASE 51 52 v SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 58 59 MAJOR MINNO VIOL. ❑ VIOLR ❑ VIOL❑ OFFICE: INSP:: �w RECEIVED BY: Mo Qpc TITLE- 2 PHONE: BECK: HUT-3 White-Original Yellow-Owner's Copy Pink-File Coov