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UN'JERGROUND TANK OFFICIAL INSPECTION REPORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r 445 N.Sen Joaquin Street <br /> (` Mailing Address: P.O.Box 388 <br /> COUNTY NAME�c� 0 Stockton,CA 95201-0388 <br /> 499.3420 COUNTY <br /> SITE NAME: -paG,` INSPECTION DATE: ���G-gSG <br /> SITE ADDRESS: 1q1,3 � y� S�• CITY/STATE/ZIP S71pc�t�� C/4 <br /> CHANGES SITE YES NO TANK T TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? OMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTI N SITE COMPUTER# UMBER NUMBER NUMBER NUMBER <br /> R# PER# PER# PER# <br /> 44 E P.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CO <br /> OPERATICIAL TANK NT IM <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 14M.oL• <br /> MONITORING RECORDS MAINTAINED 15 16 "H / C&I ,,,�+e.KYXu U <br /> ACCESS CASING SECURED 17 18 / L/�K�iiG <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 <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 W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 /> 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 8 NO L 59 <br /> VIOL. VIOL. VIO <br /> OFFICE: INSP.�Q,B, RECEIVED BY: <br /> TITLE:ZN r 6 P- S PHONE: RECK: <br /> HUT-3 While.Original Yellow-Owner's Copy Pink-File Copy 5/8e 0. <br />