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U*RGROUND TANK OFFICIAL INSPECTION ART <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 , C✓40 �-0 '/ <br /> Stockton.83422001-0388 COUNTY # / <br /> SITE NAME: J)q m/�l S R y �rC E 1 INSPECTION/DATE: �p'�y"7,j <br /> SITE ADDRESS: *075 C . fn � ' , CITY/STATE/ZIP S�DGII � /Jro� . <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK �/ TANKS TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPU R COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> ' PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPER TIONAL TANKr TANK CONTENTS 600 'az <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 7 8 <br /> APPROVED MONITORING SYSTEM 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 C <br /> PIPING 19 q24 <br /> INVENTORY RECONCILIATION 21 TANK GAUGING 23 APPROVED RESPONSE PLAN 25 UNAUTHORIZED RELEASE OCCURRENCE 27 <br /> SAMPLING 29 30 --- <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <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 /> .. .._ _. <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: Q �— <br /> 57 58 59 <br /> VIONO <br /> L R ❑ VIIOLL..R ❑ VOL.❑ <br /> OFFICE: INSP / / /,� BA; L � RECEIVED BY: <br /> T�IITTLLEE': SC}?l OP RLvJr/o7 PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/88 OM <br />