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U&GROUND TANK OFFICIAL INSPECTION R&T <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME Meiling Address: P.O.Box 388 COUNTY # <br /> Stockton,CA 01-0358 <br /> 488-3420420 <br /> SITE NAME: _ INSPECTION DATE: <br /> SITE ADDRESS: _ \ 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 # PER# <br /> EXP.DATE EXP DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK COIMNs <br /> MAJOR MINOR _ <br /> PERMIT TO OPERATE 1 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 19 20 . <br /> ___...._ <br /> INVENTORY RECONCILIATION Ti- 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 131 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W447 <br /> 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <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 IIT�TEM,�S.. REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: � '� <br /> 57 58 59 <br /> MAJOVIOL. <br /> ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: C PHONE: PECK <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />