REMOVAL_NOV 1994 - Laserfiche WebLink

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U%VERGROUND TANK OFFICIAL INSPECTION F"wORT aAQUIN PUBLIC HEALTH SERVICES WV RONMENTA HEALTH DIVISION 445 N.Son Jo Puln Street Melling Address .O.Box 388 COUNTY NAME Stockton,CA 95201-0388 COUNTY # 488-3420 SITE NAME: ' ,t,n INSPECTION DATE: SITE ADDRESS: I CITY/STATE/ZIP CHANGES SITE/OWN R/PERMIT? YES NO TANK .77 TANK TANK TANK 7!J FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER # PER# PER# PER # PER # EXP.DATE EXP.DATE EXP.DATE EXP.DATE TANK CONTENTSq` OPERATIONAL TANK MAJOR MINOR PERMIT TO 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 PLAN 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 REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORINO 44 45 ERMANENT TANK CLO R� REM IDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 58 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:�� 57 58 59 MAJ NO VIOL R ❑ VIOL. ❑ VOL.❑ --_�—_ OFFICE: INSP: RECEIVED BY: Qi Ev`�rl - TITLE: /0 ' PHONE: HECK HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy fi/e6 ®M