Laserfiche WebLink
1 RGROUND TANK OFFICIAL INSPECTIONFRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENAL HEAITT,�DIVISION <br /> 304E. eber Ave., hir Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201.0388 COUNTY N <br /> A A 4883420 <br /> SITE NAME: "11 INSPECTION DATE: r7 <br /> SITE ADDRESS: 11 CITY/STATE/ZIP <br /> CHANGES SITE 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 0 PER # <br /> EXP.DAFE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENT$ <br /> OPERATIONAL TANK > ,' jlt-r�u, jaj`ryl <br /> MAJOR MINOR — , `a.�'- <br /> PERMIT TO OPERATE 1 2 Y <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 ` <br /> WRITTEN MONITORING PROCEDURES 7 8 1 <br /> APPROVED MONITORING SYSTEM 9 TO <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 /> .NVENTORY 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 REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY IIAZARD 35 36 <br /> CONDITIONS ABATED V1, 37 <br /> TEMPORARY TANK CLOSURE e "m <br /> ? TAY <br /> REMOVAL OF RESIDUAL W4445 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED 3 <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE !4 ��? IT ';�` �',4 � �I <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50Im <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT YIOLATIONS <br /> �AND MUST BE COR.REECTEEDD AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS.: Alp <br /> —F-[LJi`� �11.E— O� <br /> a <br /> 57 58 59 1 <br /> NO <br /> VIOL"" ❑ VIIOLR ❑ VOL.❑ <br /> OFFICE: INSP: RECEIVED BY: 7 <br /> TITLE: PHONE: HECK: <br /> NUT-3 While.Original Yellow-Owner's COPY Pink File Copv <br /> PHS 178 (4196) <br />