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UND&ROUND TANK OFFICIAL INSPECTION REP91 <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 <br /> Stockton, <br /> CA 01-0388 COUNTY # <br /> 83420 <br /> SITE NAME: INSPECTION DATE: 5 C_ <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? ES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER p��rd_V/ NUMBER 1�51.d 2 NUMBER/`t.?- NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# T PER# N� PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIO AL TANK TANK CONT N s <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORINGT 11 12 � <br /> APPROVEDEDMONITOR <br /> FREQUENCY <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 _ <br /> APPROVED RESPONSE PLAN :25Z 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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL U43 <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 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 63 54 _. .. _ .. <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:t6 E <br /> i <br /> 57 58 59 <br /> VIOL. ❑ MINOVIOL.R ❑ VOL.LJ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE:- PHONE: RECK: <br />