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U***+iGROUND TANK OFFICIAL INSPECTION REy,oOgT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> COUNTY NAME 445 N.Sen Joaquin Street <br /> Mailing Address- P.O.Box 399 <br /> kilt � Stockton,ton.CA 95201-0398 <br /> SITE NAME: <br /> 499-3420 COUNTY # <br /> SITE ADDRES9 <br /> L _� n <br /> CI��-P�' INSPECTION DATE: <br /> S: <br /> CHANGES SITE/O NER/R I? ES NO NK CITY/STATE/ZIP L_ <br /> FORM A AND/OR B SUBMITTED? COMPUTER TANK ((�� TANK TANK <br /> NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION NUMBUTER# ER COMPUTE <br /> COMPUTER COMPUTER <br /> SITE COMP / <br /> 7/ PER# PER# /� PER# <br /> PER # <br /> EXP.DATE EXP.DATE EXP.DATE <br /> OPERATION L TANK TANK coNTEN75 EXP DATE/ <br /> MAJO INOR <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 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <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 50MR <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: ttr Gll' I <br /> Vw.1 s <br /> MAJOR �5j7� MINOR 58 NO 59 <br /> VIOL, L VIOL. El VIOL.❑ -)0 ai 1•.... n.W+T1+aQ• S <br /> f 0 S T I <br /> rAffcoP r il. a <br /> OFFICE: INSP: RECEIVED <br /> cc,,..t�.a <br /> TITLE—S n I oO— 7 70 - PHONE: RECK <br /> u,iT—v va.t .nrinincl Yellmv-Owners copy Pink-File Copy <br />