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UIQ• ERGROUND TANK OFFICIAL INSPECTION RR10111,6RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> COUNTY NAMEJo P,n�G 445 N.seP- S <br /> Joaquin treet <br /> Mailing Ad on s: O. tr388 <br /> Stockton,CA 95201-0388 <br /> SITE NAME: el <br /> 468-3420 couNfr #3 <br /> i t I 1 <br /> INSPECTION DATE: a-tel oZ_y <br /> SITE ADDRESS: 13 /3 r ip /1 <br /> T (��{Ge� CITY/STATE/ZIP s f CK�,,,, Cf 9$ad <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK 2 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER TANK <br /> TYPE OF INSPECTION NUMBER COMPUTER COMPUTER COMPUTER <br /> SITE COMPUTER# NUMBER NUMBER NUMBER <br /> c;z b PER# PER# PER# <br /> EXP.DATE PER# <br /> OPERATIONAL TANK EXP D��nyrE EXP DATE EXP DATE <br /> TANK CONTENTS <br /> J <br /> PERMIT TO OPERATE MAJOR MINOR1 2 yV 4— <br /> ILL <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 / <br /> APPROVED CONSTRUCTION 5 6 4/ ✓ f <br /> WRITTEN MONITORING PROCEDURES 7 6 <br /> APPROVED MONITORING SYSTEM 9 10 ✓ / <br /> MONITORING SYSTEM 11 12 v <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 76 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING23 24 ---"—- "--- <br /> APPROVED RESPONSE PLAN 25 26 -- "-- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 - " <br /> SAMPLING —.___.... <br /> 29 30 <br /> APPROVED TANK REPAIRS 31 32 �- <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W" 45 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 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 /> SAMPUNG 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MINOR NO <br /> VIOL R ❑ VIOL ❑ VOL.❑ <br /> OFFICE: INS <br /> P: r Q RECEIVED <br /> TITLE:-Wi o e RE H S ONE I RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv 5/88 O M <br />