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*RGROUND TANK OFFICIAL INSPECTION R*RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY <br /> 468.3420 <br /> SITE NAME: ` INSPECTION DATE: 17 9b <br /> SITE ADDRESS: l CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER+► PER # PER # PER # PER # <br /> EXP.DAI E EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONIENTS +: <br /> OPERATIONAL TANK MAJOR MINOR ,7 f 1 <br /> :' ' <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 B <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONO TORING SYS I EM 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 L37 <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY IIAZARD <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 m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> , -a "fie S i •i a's Iii ^ s <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 ONE) FOLLOWS:MA, <br /> 57 58 59 <br /> NO <br /> VIOL..R © VIOLL..R ❑ VOL.❑ __ _ <br /> OFFICE: INSP: RECEIVED B <br /> PHONE: RE K' _ <br /> HUT--3 While-Original Yellow-Owner's Copy Pink-Fite Copv <br /> PF15 178 (4196) <br />