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U&GROUND TANK OFFICIAL INSPECTION REI&T SAN JOAOUIN PUBLIC HEALTH SERVICES ENVIRONMEE ET41-HEAin I� P,VISION Mailing Address:P.O.Box 388 COUNTY NAME Stockton,CA 85201-0388 COUNTY # 488-3420 / SITE NAME: OG 4 E `TZACy S-rAcn0►� INSPECTION DATE SITE ADDRESS: Z,yC)a l �� pQ` � � ASS CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK 1-4.0403 TANK t-+0-40� TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBERNUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER♦ PER OF f U L PER# D(e, PER # PER a F�OL,+A c, 1-40) EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK T 14K CONIENTS MAJOR MINOR A - PERMIT 70 OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 , APPROVED RESPONSE PLAT! 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE a a. A.I� REMOVAL OF RESIDUAL W44t45 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 A9 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 5A IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(must MARK ONE) FOLLOWS:------------ 57 OLLOWS: — -- — -- NO VIOLOR LJMINOVIOL.R ❑ OL.❑ -- -- OFFICE: INSP: ��.,�J�l.� REED BY: /I c� �`CIT16C`„ /5! PHg�oE: -5 35- 49 3 HEC 01 TITL HUT-3 White 01191nai YBIIOW-Owner's COPY Pink-File Copv PHS 178 (4/96)