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UI. ,.RGROUND TANK OFFICIAL INSPECTION R.._ TRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Melling Address: P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: t✓S Q INSPECTION DATE: <br /> SITE ADDRESS: U/ p CITY/STATE/ZIP S X <br /> CHANGES SITE/OWNER/PERMIT') YES NO TANKTANK O TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEFOF / COMPUTER�p�� COMPUTER COMPUTER <br /> TYPE OF INSPECT N SITE COMPUTE"Rye#� PER NUMBER/, ,�p� PER#NUMBE/I�'"— PER NUMBER PER B#ER <br /> 7 O EXP.DATE UV EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCo1MWTS <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 /> 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 k1334SAFETY HAZARD 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> i,. <br /> REMOVAL OF RESIDUAL 38 39 _-- <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 / <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATO 44 45 " <br /> ERMANENT TANK CLOSURE <br /> RE RIALS 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 /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL WJ <br /> OFFICE: � INSP: A iREGIEWED BY: <br /> /Z TITY,LLE: PHONE: PECK: <br /> HUT-3 White-Original Yellow-Owners Copy Pink-File Copy 5isa 0. <br />