Laserfiche WebLink
�RGROUND TANK OFFICIAL INSPECTION &T <br />• SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTYALea HEeALT H DIVISION <br />Meiling Address: P.O. Boz 388 <br />ff UNTY NAME Stao1don,CA95201.0388 COUNTY # <br />SITE NAME: C A l _yt_�S <br />ry,Y <br />1_ <br />l Y,C <br />INSPECTION DATE: (C/� <br />/6 / <br />SITE ADDRESS: S W a <br />I C� <br />CITY/STATE/ZIP <br />;SSC <br />OI SS -7 <br />CHANGES SITE YES <br />Y40 <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />—COMPUTE <br />COMPUTER <br />NUMBER I-G,,r( <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION SITE <br />R + <br />PEER s <br />PER a <br />PER :r <br />PER t <br />v�, Ig�� <br />EXP DATE <br />EXP DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTEN/S <br />WwoR MINOR <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 />/ <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />•� <br />APPROVED MONT TORING 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 />T8 <br />. <br />PIPING <br />20 <br />INVENTORY RECONCILIATION <br />22 <br />__..._-_.. . . .. .... .......__ _ <br />., _..,.,_ _..._..... <br />TANK GAUGING <br />[23 <br />24APPROVED <br />RESPONSE PLAN <br />26 <br />✓UNAUTHORIZED <br />RELEASE OCCURRENCE <br />28SAMPLING <br />30APPROVED <br />TANK REPAIFIS <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY I IAZARD • <br />"3536 <br />CONDITIONS ABATED <br />AI <br />1(• <br />TEMPORARY TANK CLOSURE <br />`A; <br />3» <br />w . <br />:a.R <br />REMOVAL OF RESIDUAL• <br />FLAMMABLE VAPORS REMOVED <br />_ <br />ACCESS LOCATIONS SEALED <br />444t <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE• <br />I <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 <br />REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:-------- <br />OLLOWS: <br />— <br />— <br />57 <br />NO <br />❑ ❑ <br />❑ <br />.— —. <br />_—._____.__---. <br />VIOLR VIIOLR VOL. <br />-- <br />— <br />OFFICE: <br />IjSP: <br />1, <br />RE <br />EIVE BY: <br />PHONE: <br />HECK: <br />T. .� 1'L+ <br />HUT -3 White - Original Yellow owner's copy Pink - File Copv <br />PHS 178 (4/96) <br />