Laserfiche WebLink
UORGROUND TANK OFFICIAL INSPECTION RISRT <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 Stockton,CA 95201-0388 <br /> 468-3420 COUNTY # <br /> SITE NAME: V; C 6rvierq( INSPECTION DATE: s e 34;y <br /> SITE ADDRESS: LA H O1 q G too CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK TANK Z TANK 73 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> © r / PER# PER # PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS ` A)/f, n <br /> MAJOR MINOR a? WC) �/ G' G)Oi) <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 27 22 <br /> TANK GAUGING 23 24 - <br /> __ <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 CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 ON FOLLOWS: <br /> MAJOR 57 MINOR 5 NO 59 <br /> VIOL. ❑ VIOL. VIOL.❑ <br /> gq d/ rl <br /> OFFICE: INSP: RECEIVED BY: <br /> (5XI)y68''-033 41 <br /> TITLE: PHONE: <br /> HUT-3 White-Original Yellow-Owners Copy Pink-File Copy 5/88 ON <br />