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UI,el,,AGROUND TANK OFFICIAL INSPECTION RE.,..,iT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEA�T,�DIVISION <br /> 304 E.Weber Ave., hir Floor <br /> Meiling Address:P.O.Box 388 <br /> COUNTY NAME S1ocl4on.CA9UOI-0388 COUNTY # <br /> 488-3420 <br /> SITE NAME: Sr/� Gt/EyT G 2Qvoi2 INSPECTION DATE: C7 <br /> SITE ADDRESS: ZyyCITY/STATE/ZIP Sys/Cge��y�p <br /> CHANGES SITE YES NO TANK d- / TANK +rtL TANK Alf TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER FO,4 NUMBER `1011 NUMBER /O,Ulm NUMBER <br /> TYPE�OF INSPECTION SITEE COMPUTER/ PER# PER# PER 0 PER R <br /> ,CS/f7Tl So 535`7 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONlEN15 <br /> MAJOR I MINOR 1& .1 ".1 <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 SYSI EM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 IB <br /> PIPING 19 20 r <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAT) 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 I-IAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE r�.n r } t p s a j�l 1 <br /> 4C �"1� rTi T1 f <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 MOST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE1 FOLLOWS: � •RE4 — <br /> 57 58 59 <br /> MIN <br /> NO <br /> V <br /> IOL <br /> ❑ 'AOL.R ❑ VIOL.El <br /> OFFICE: INSP:A. 141_-rte MREC11TITLE: �r� � -� <br /> HUT-3 White-Original Yellow,-O"eis COPY Pink-File Copv <br /> PHS 178 (4/96) <br />