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&ROUND TANK OFFICIAL INSPECTION*RT <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 Stockton,CA 95201-0368 <br /> 468-3420 COUNTY # <br /> SITE NAME: S INSPECTION DATE: 7lZS�ti <br /> SITE ADDRESS: /9`J� _ r / CITY/STATE/ZIP <br /> /V Ac.4/-,P10 �0 5-4-ZZ <br /> SITE YES NO TANK *6 � TANK a 'L TANK � TANK � c <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTI .N SITE COMPUTER# NUMBER/OK NUMBER /O I, NUMBER ',SoJ NUMBER 6 k <br /> PER# PER# PER# PER # <br /> vT ~ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONreNTs <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 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 <br /> PIPING 20 - -- ✓ ✓ <br /> INVENTORY RECONCILIATION 21 22 <br /> NK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 26 L 6 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 2930 <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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) FOLLOWS: <br /> 57 58 59 <br /> MAJNO <br /> VIOL, <br /> ❑ VIOMINOR❑ VOL.❑ <br /> OFFICE: INSP: P/G RECEI D BY: <br /> TITLE: �f� PH Q E: K: <br /> Zoq,�-o33?j <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/88 Om <br />