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AGROUND TANK OFFICIAL INSPECTION RIORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME Mailing Address: P.O.Box 388 COUNTY # <br /> Stockton,CA 95201.0388 <br /> 468-3420 <br /> SITE NAME �1 ll evA ,J�_ 5� ���� r� r5 INSPECTION DATE: <br /> SITE ADDRESS: 1 Lr )7 S )4,j 2 CITY/STATE/ZIP L <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 1` 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 /> © I � EXP.DATE EXP.DATE= EXP.DATE EXP,DATE <br /> OPERATIONAL TANK TANK CONTENTS �- <br /> MAJOR MINOR 1-5620 <br /> r <br /> S 620 +-1 G / dem <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 ✓ of <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 135 136 <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 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 ME I <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 56 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INS�P: / RECEIVED BY: <br /> TITLE: PHO E: BECK: <br /> HUT-3 White-original Yellow-Owner's Copy Pink-Fiie Copy 5/88 Om <br />