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UI✓ERGROUND TANK OFFICIAL INSPECTION R✓JRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (-� 445 N.San Joaquin Street <br /> v �� e Mailing Address: P.O.Box388 <br /> 8 <br /> COUNTY NAME S ock o 46934 i-0388 COUNTY # <br /> 32 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: /� JW a rJ(/ `C CITY/STATE/ZIPG <br /> CHANGES SITE/O N R/PERMIT? YES O TANK / TANK :EXPDATE <br /> TEXP. <br /> / <br /> ORM A AND/OR B SUBMITTED? COMPUTER COMPUTER TER TER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER R R <br /> FO'I PER# PER# <br /> EXP.DATE EXP.DATE E <br /> OPERATIONACTANK TANK CONTENTS LUJ457E Gi <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 /> _.._ <br /> TANK GAUGING 23 2q <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 2g 30 - -- <br /> APPROVED TANK REPAIRS 31 32 <br /> _.._ .... <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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) FOLLOWS: �"� <br /> 57 58 59 <br /> OL. ❑ VIOL. ❑MAJOR MINOR V- <br /> 6Z. 4.. __.. <br /> OFFICE: INSP: RECEIVE BY: <br /> TITLES r-A)10 rV P F- H S PHO�NNZ o�s RECK: <br /> HUT-3 White-Original Yellow-Owners Copy Pink-File Copv 7 5/88 (;M <br />