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• ' U*G–ROUND TANK OFFICIAL INSPECTION RA • SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL TYEAL T H DIVISION _ Mallinpnon,C e:P.O.Box-0388 COUNTY # .. ` Stockton,CA 42001-0388 COUNTY NAME `„".� J ace-3azo SITE NAME: 6 _Z7so INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP 3Lk,� CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK 2 TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTeR3 COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER d PERF /0/010 O PER r /0101'— PER • � PER a 'I/d II I EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK COMENTS . "�• '. N" ) I 1 OPERATIONAL TANK w4jOR MwoR U F V PERMIT TO OPERATE 1 2 �I CHANGE IN CONDITIONS TO OPERATE 3 4 ✓ / ✓ APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 ✓ 8 ✓ ✓ ✓ APPROVED MONITORING SYS]EM 9 10 MONITORING SYSTEM 11 12 ✓ APPROVED MONITOR FREQUENCY 13 14 ✓ ✓y MONITORING RECORDS MAINTAINED 15 16 10111 f ACCESS CASING SECURED 17 18 PIPING 19 20 ✓ / INVENTORY RECONCILIATION 21 22 TANK GAUGING ' 23 24 APPROVED RESPONSE PLAN 25 ✓ 26 ✓ UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 ---. ._ APPROVED TANK REPAIFIS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY FIAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSUREitl nK+ 'r1 1�> 'pllt � f;, REMOVAL OF RESIDUAL' 38 39 FLAMMABLE VAPORS REMOVED 4U ACCESS LOCATIONS SEALED AI A2 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 Mf,fp 1 d�r� 7 PERMANENT TANK CLOSURE It iP �g k,?;�ka REMOVAL OF RESIDUAL:MATERIALS 41-6 47 PIPING 48 49 FLAMMABLE VAPORS R%MOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 V 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE)57 FOLLOWS: -- VIO OR LJVIOL. 58 NO 59 ❑ VOL.❑ —----.--_ OFFICE: INSP: , A RECEI BY: TITLE, PHONFr: LC). ( BECK: 1j6 I IUT-3 White'Original yellow.Owner's Copy Pink-File Copy PHS 178 (4/96)