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UMPIMGROUND TANK OFFICIAL INSPECTION REvE/IiT <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMa ETkL Hbw EeA1 TM DIVISION <br /> 4 Meiling Address:P.O.Box 38B <br /> COUNTY NAME Stockton,468c 9 pm-0388 COUNTY # <br /> SITE NAME: v G �7 INSPECTION DATE: Z9 <br /> SITE ADDRESS: �Z�O� EJB—�oA� CITY/STATE/ZIP C4 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK a & - TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER♦ PER# PER 0 PER I PER 9 <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> UWCOMENtS <br /> OPERATIONAL TANK Miwion MINOR •r ! , <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 SYSIEM 9 t0 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 I6 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING i9 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 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY IIAZARD 35 36 <br /> CONDITIONS ABATED 37 — -- <br /> TEMPORARY TANK CLOSURETly <br /> 1T[" ,• <br /> ANN a> <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(MUS1 MARK ONE) FOLLOWS: ri��Z 00GK — -- <br /> 58 i9 <br /> VO OR VINO <br /> I() <br /> L. _ -- -- <br /> OFFICE: INSP: �Z! '^ RECEIVED BY: <br /> TITLE: p0� PHONE: HECK <br /> HUT-3 While-Original Yen"-Owner's COPY Pink-File Copy <br /> PHS 178 (4/96) <br />