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UN'ftRGROUND TANK OFFICIAL INSPECTION REPORT <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 ��tti pStockton,6CA 83420 95201-0388 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: /9�d CITY/STATE/ZIPS4vCW&'/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK#a (Upsf TANK �_3C 51' TANK TANK <br /> M <br /> FORM A AND/OR B SUBMITTED? Cot COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> Tit 1u K PER # PER# PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS �... <br /> MAJOR MINOR 2. <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 Vf / <br /> APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 12 (flD yylp)e,f CLrMn le 1'ee <br /> APPROVED MONITOR FREQUENCY 13 14 q /� <br /> MONITORING RECORDS MAINTAINED 15 16 I'a.—to- <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 V/ <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 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE 7.. <br /> REMOVAL OF RESIDUAL W437 <br /> 9 <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 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) <br /> FOLLOWS: CLC <br /> 57 58 NO 59 <br /> VIO <br /> MAJOR Li VIOLMINOR ❑ VIOL❑ r " ya4^,y7A, <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE:, " S E S NE <br /> SS RECK <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />