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r <br /> • U&GROUND TANK OFFICIAL INSPECTION R&T <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,468-3420 01 3388 COUNTY # <br /> SITE NAME: INSPECTION DATE�r_I/ <br /> /L �l <br /> SITE ADDRESS: -7� f / CITY/STATE/ZIPf <br /> CHANGES SITE/ WNER/PERMIT? YES O TANK TANK Z, TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTE ��,,tt-� COMPUTER <br /> TYPE OF INSPECTION SITE COMPR# NUMBER �y / NUMBER J � NUMBER r&1z v NUMBER <br /> ' <br /> 17;* <br /> PER # /I" PER# PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK NTS �ORPERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE 3 0014 <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 <br /> MONITORING RECORDS MAINTAINED 15 16 ✓! <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 124 <br /> APPROVED RESPONSE PLAN 125 26 j i <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 y/ y`/ <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33' 34 P <br /> SAFETY HAZARD 35 V 3 <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 44 145 <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 S/ATUS(MUMMARK ONE) FOLLOWS: 7 <br /> MAJOR INOR58 NO59VIOL. OL. ❑ VIOL.❑ <br /> OFFICE: INSP EGEIV D BY: 0 <br /> TITLE: y��� N �� ���� RACK: <br />