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U&GROUND TANK OFFICIAL INSPECTION R T <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTS L be,HEAL H DIVISION <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME slxk+°4s 3A2op1-o3as COUNTY <br /> SITE NAME: INSPECTION DATE: V7d <br /> SITE ADDRESS: .41© CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER # PER # <br /> EXP,DAFE EXP DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONVENTS !; is 14"!p 4 ijkS. <br /> MAJOR M91JOfi <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 SYSIEM 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 REPAIFIS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY IIAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE l <br /> REMOVAL OF RESIDUAL" 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 43 <br /> OWNER/OPERATOR MONITORING 144 45 <br /> PERMANENT TXNK CLOSURE tj�A��!yr,� ttl <br /> ,.yam+^ �; d YyYI <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 63 64 <br /> IMPROPER ABANDONMENT 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND FAUST BE CORRECTED AS <br /> SYSTEM STATUS(MUSE MARK ONE) FOLLOWS: --- -� -- <br /> 59 <br /> MAJOR 57 MINOR © NO ❑ <br /> VIOL. ❑ VIOL. VIOL. -� -- <br /> OFFICE: MSP: <br /> ;ReECEIV3Y: <br /> TITLE:Z�,I I ComBECK. <br /> I AUT-3 WhI1e-Original Yellow-Owner's Copy Pink-Fila Copy <br /> PHS 178 (4l94) <br />