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, NMYERGROUND TANK OFFICIAL INSPECTION-,. hART <br /> • SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEAITM7�DIVISION <br /> W <br /> 304 E. Ixr A", r lour <br /> MAHN A4 :P.O.1W1 3W <br /> COUNTY NAME Sa iW S'aa w CA D 1-03W COUNTY #,3 <br /> /� 4843120 <br /> SITE NAME: C Q�d S t c, l" �O �" INSPECTION DATE: <br /> SITE ADDRESS: l5 O �nti"'�U CITY/STATE/ZIP <br /> CHANGES SITE/OYJNER/PERMIT? YES NO TANKTANK TANK TANK aV <br /> FORM A AND/OR B SUBMITTED? C ER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER A PER 4 PER 0 PER• PER <br /> 1 EXP.DAIE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK iiiiion I �7.ry1 <br /> PERMIT 10 OPERAI E 1 2 <br /> CHANGE IN CONDI IIONS 10 OPERATE 3 4 <br /> APPROVED coNsTRUCIK)N 5 8 <br /> WRITTEN MONITORING PROCEDURES 7 B <br /> APPROVED MONITORING SYSTEM 9 IU <br /> MONI TORINO SYS I EM 11 12 <br /> APPROVED MONIIOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAIN PAINED 15 16 <br /> ACCESS CASII4G SECURED 17 18 <br /> PIPING 19 20 <br /> :NVFNTORY RECONCNJA110N 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 29 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHOOZED RELEASES REPORTED 33 37 <br /> SAFETY IIAZARD 1 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL' W--t4�-3 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT T/WK CLOSURE "I' 1 ���• �' 11l +.'�I ' <br /> REMOVAL OF RESIDUAL MAIERIALS 46 47 <br /> PIPING 46 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 ✓ <br /> T14E MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS IMUSr MARK CHET FOLLOWS. <br /> MA.IOR 57 MINOR 58 NO 59 1 QI.rC�LCJ <br /> VIOL. ❑ VIOL ❑ _ NOL.❑ <br /> OFFICE: =r. i5. <br /> .3Y3 • )11CL�.r1. 5�'1 <br /> 01, <br /> 0 G K�✓1 ]�,�//} RecK <br /> HUT-3 Wh8•'Or1g1 0 Y^e° 0 .0".Cagy PInB-FH8 CM� <br /> PH5178 f4/981 <br />