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UNLOGROUND TANK OFFICIAL INSPECTION REST <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 �� ; z Stockton, <br /> CA 468-3420 01-0388 COUNTY #3 <br /> SITE NAME: a S f r e- INSPECTION DATE: 54-17- <br /> SITE <br /> 4_/7-SITE ADDRESS: l <br /> r �� ���� CITY/STATE/ZIP SfOGf�' �1�i9 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKTANK <br /> TANK 3 TANK <br /> 3- <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> n �.1-1PER # PER# PER # PER# <br /> 1 1 me, <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS--- - /;t Wo r A j - / , v-v <br /> MAJOR MINOR tJJT� cZ-C., 4Y ^VV '•"S <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 /> _.___...__.____-__..___.-- .___._____ <br /> ..___.. <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 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 <br /> CONDITIONS ABATED <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 <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) FOLLOWS: __,CL�, i �. <br /> VIOMAJOR 57 58 NO 59❑ VIOLR ❑ VIOL. W --- <br /> nklv- <br /> OFFICE: INSP/f�Q r RECEIVED BY: r <br /> TI� /b <br /> :, /,i R6�S PHONE: RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />