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UAGROUND TANK OFFICIAL INSPECTION REOT <br /> 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 �� '^ - Stockto ,8CA 342001-0388 COUNTY # 3 <br /> SITE NAME: / INSPECTION DATE: <br /> SITE ADDRESS: v // ,/� l/,j CIT Y/STATE/ZIP�� . <br /> CHANGES SITE/OWNER/PERMIT? AYES NO TANK" TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER© _f,n'} NUMBER NUMBER NUMBER <br /> PER# <br /> TYPE OF INSPECTION SITE COMPUTER # ,r��U PER # PER# PER # <br /> V U � EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 23 124 <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 CLOSURE41 <br /> ��° Y <br /> REMOVAL OF RESIDUAL W45 <br /> 39 <br /> FLAMMABLE VAPORS REMOVED mm <br /> ACCESS LOCATIONS SEALED 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING <br /> 4. <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 153 154 <br /> IMPROPER ABANDONMENT 155 156 _ <br /> TH MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS{MUST MARK ONE} FOLLOWS <br /> 57 5B 59MAJO - - — - <br /> NOR No <br /> VIOL. <br /> ❑ VIOL. ❑ VIOL.❑ _a <br /> OFFICE: INSP. RECEI D BY: <br /> ` � . <br /> TITLE:or, � P ON RECK: <br /> 1UT--3 W�ito-00cinel Yellow-Owner's Copy Pink-File Cnpy " <br />