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UAklr[RGROUND TANK OFFICIAL INSPECTION RET•AhT <br />• SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMEENT1A LHAE•AL+T•.H TrdPkkVISION <br />304 E.Meiling Address: P.O. Bax 388 <br />COUNTY NAME ga"mJ _�"oa ggzz J.v Stockton, �CA95201-03M COUNTY #37 <br />SITE NAME:D / / <br />` <br />S f� <br />INSPECTION DATE: <br />SITE ADDRESS: <br />���� <br />CITY/STATE/ZIP 3/p ( ffv66o v <br />CHANGES SITE/ R PERMIT? <br />YES <br />NO TANK 04 <br />TANK C) 7 <br />TANK <br />TANK <br />FORM A AND/OR 8 SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />PER 0 <br />COMPUTER <br />NUMBER <br />PER 0 <br />COMPUTER <br />NUMBER <br />PER R <br />T^^YnnP__E OF INSPECTION <br />SITE COMPUTER I PER 0 <br />150&1-Y�CJ <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />'+ee- <br />lAAJO/I MINON "I _ '1% i t. <br />•vl-. <br />PERMIT 10 OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />IU 0 n � <br />G - <br />d7 <br />MONITORING SYSTEM <br />11 <br />i2 J <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 �4 A� / <br />(/ <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />PIPING <br />17 <br />19 <br />18 <br />20 <br />a <br />^ <br />INVENTORY RECONCILIATION <br />21 <br />22 A2 <br />_,.. <br />TANK GAUGING ' <br />23 <br />24 <br />��_ mar <br />' <br />r_ <br />APPROVED RESPONSE PLAID <br />25 <br />26 <br />oe <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />I <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />7,, <br />37 <br />• <br />TEMPORARY TANK CLOSURE <br />a <br />,, .-� f ' s + °• "+ .N,��(+ <br />REMOVAL OF RESIDUAL" <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W14 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />r�'I�� <br />�i°. 1 X31 ,'j <br />• <br />REMOVAL OF RESIDUAL. MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS RkMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS 1MUS1 MARK ONE) <br />FOLLOWS: JZtA� <br />p(2 !,C� <br />57 5B <br />MINVIOLOR ❑ ❑ <br />59 <br />❑ <br />VIOL. VIOL. <br />OFFICE: <br />INSP:Y' <br />TITLE: C L! S <br />RECEIVED BY: <br />PHONE: <br />HECK <br />1 <br />r I <br />HUT -3 White - Original Yen" - Ov er's Coot Pink - File Coov <br />PHS 178 (4/96) <br />