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UXRGROUND TANK OFFICIAL INSPECTION REPORT <br />SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />COUNTY NAME• Mailing Address: P.O. Box 388 <br />Sp�ry 2 0�., Stockton, CA 95201-0388 nmrury <br />- - <br />488-3420 <br />UWE!I1 v -c <br />SITE NAME:eiYYleil� O <br />r 0 <br />�� } <br />1 <br />V <br />INSPECTION DATE:�jr g� <br />SITE ADDRESS: A5a 3� <br />c <br />Sr✓ Q 7`fs <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />TANK <br />COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECT N SITE COMpUTVR # <br />{� A U / <br />NUMBER <br />(y PER # <br />NUMBER NUMBER NUMBER <br />PER <br />.. 6� 5 <br />/7•N l�-CJ �J ([�(` <br />O <br /># PER # PER # <br />OPERATIONAL TANK <br />EXP. DATE <br />TANK COH NTS L C�cGe <br />EXP. DATE EXP. DATE EXP. DATE <br />MAJOR MINOR s> <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 />/6 <br />ACCESS CASING SECURED <br />17 <br />18 r- <br />VI y <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 / <br />TANK GAUGING <br />23 <br />_. <br />// <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING._ <br />29 <br />_. _.._._.,.___.....__..__ <br />30 <br />.. <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 />38 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />r4� <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <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 />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: S,� <br />a- <br />57 58 <br />MAJOR NO 59 <br />❑ R ❑ ❑ <br />-__- <br />OL. VIOL. OL <br />OFFICE: <br />INSP- <br />E' S <br />RECEIVED <br />BY: <br />TITLE: <br />Sj5 <br />v1,o -' <br />PHONE: <br />RECK: <br />HUT -3 V&.ite - Original Yellow - Owner's Copy Pink - File Copy <br />