COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Uh,w.RGROUND TANK OFFICIAL INSPECTION R. RT SAN JOAQUIN PUBLIC HEALTH SERVICES v ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street COUNTY NAME Mailing Address P.O,Box 388 Stockto 468-3420 CA 01-0388 COUNTY # SITE NAME: � `' ICi CK11 1�v1 INSPECTION DATE: G YV SITE ADDRESS: DOC CITY/STATE/ZIP CHANG ORM AEAND/OR B SUBMITTED?—YES NO TANK COMPUTER S TANK G TANK -7 TANK TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER COMPUTER NUMBER ER NUOMBERER PER# PER# PER# PER# J EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK WKccll rl rs MAJOR MINOR ,':[R,.v PERMIT TO OPERATE 1 2 L CHANGE IN CONDITIONS TO OPERATE 3 4 f APPROVED CONSTRUCTION 5 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 Ti— 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 ,/ ./ ✓ UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 2 xi- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4445 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM S/57 UST MARK ONE) FOLLOWS: MAJOR MINOR 58 NO 59VIOLVIOL. ❑ VIOL.❑ OFFICE: INSP:,, RECEIV BY: TITLE: PHONE: ECK. HUT-3 White.Original Yellow-Owner's Copy Pink-File Copv sisx nM