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ARGROUND TANK OFFICIAL INSPECTION ART SAN JOAOUIN PUBLIC HEALTH SERVICES ENVIRONMENTALHEA HEALTH Weber Mailing Address:P.O.Box 388 COUNTY NAME Stockton,68 342oa1 �� COUNTY # SITE NAME: INSPECTION DATE: 8 SITE ADDRESS: CITY/STATE/ZIP CHANGES SITE YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER * PER X PER PER PER 9 EXP.DAI E EXP.DATE EXP.DATE EXP.DATE TAME CONIENts OPER TI03�IAL TANK MAJOR iAiRaR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONI IORING SYSI EM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 :k4VFNTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY IIAZARD 35 35 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 145 - PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 501 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOL TIONS AND MUST BE CORRECT ED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 MINOR 58 NO 59 VIOL.MAJOR ❑ VIOL. ❑ VIOL.❑ —._ — — OFFICE: INSP: RE EE D BY: TITLE: PHONE: BECK: I ILIT-3 While•Original Yellow-Owner'g Copy Pink-File Copy I'[TS 178 (4196)