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y6- - F-7 0-7 <br /> U RGROUND TANK OFFICIAL INSPECTION *RT <br /> SAN JOAOUIN 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: INSPECTION DATE: <br /> SITE ADDRESS: /�f CITY/STATE/ZIPS - � <br /> CHANGES SITE/OWNER/PERMIT? YES /NO TANK 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 # PER# PER # <br /> 0!/ �/-f- EXP-DATE EXP_DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCDNTENTS <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 33 34 <br /> SAFETY HAZARD 35 136 <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 m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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) FOLL WS: <br /> nada ✓ � rn�'' i` a - <br /> MAJOR 57 <br /> MINOR LJ NO 59 <br /> VIOL. <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: REG LVED <br /> C <br /> TITLE: P E: BECK: <br /> UT-3 White-Original Yellow-Owner's Copy Pink.File Copv sraa O n, <br />