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4sDERGROUND TANK OFFICIAL INSPECTIOIv%,oIPORT <br />1 SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton. CA 95201.0388 COUNTY # <br />468-3420 <br />SITE NAME: T�/� �1 ts,r-� cd, rG INSPECTION DATE: Z�49 <br />HUT -3 White - Original Yellow - Owner's Copy Pink -File Copy 5/88'�' <br />` <br />SITE ADDRESS: /ZZ_ C r' 2.040 <br />,445 <br />CITY/STATE/ZIPLp0=/c4 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK / <br />TANK Z <br />TANK z, <br />TANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTE <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CON !NnFS <br />MAJOR MINOR F!:, <br />PERMIT TO 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 />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <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 />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />U43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />56 "� <br />✓ 1� <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS tMUST MARK ONE) <br />FOLLOWS: SE'E /�iyp—C Ci <br />58 <br />59 <br />1 NO <br />❑ <br />❑ <br />VIOLOR SCJ VIOLL..' VIOL <br />OFFICE: <br />INSP;,�5,-_3 <br />RECEIVED BY; -4,4y4(%4 n: 3 6•L / v/'PE,c - <br />r <br />TITLE: /P. E• �/ S . <br />PHONE < %3 7 �� <br />RECK: <br />HUT -3 White - Original Yellow - Owner's Copy Pink -File Copy 5/88'�' <br />