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- NCERGROUND TANK OFFICIAL INSPECTIOP.. $.ART <br /> • SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEATNid RIVISION <br /> 3a E.Wtw Aw., <br /> Mwlh ro Ae4.•n:P.O.Sm 306 <br /> COUNTY NAME SNaGvIJ s'a"° �1'07°4WCDUNTT #,3 <br /> SITE NAME: c42:l6Jd -S-aGK , <br /> INSPECTIONDATE: <br /> SITE ADDRESS: /� CITY/STATE/ZIP <br /> f u 1 <br /> CHANGES SITE YES NO TANK TANK TANK TANK <br /> FORM A AND/OR 8 SUBMITTED9 C OMPUTn COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER <br /> PER / PER • PER / PER <br /> EXP.DAZE EXP.DATE EXP.GATE EXP.DATE <br /> 111NR <br /> OPERATIONAL TANK CONTENT• ' �'�' .'. li.r4•'ry: iii°� <br /> PERMIT TO OPERAIE 1 2 <br /> CI4ANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 IU <br /> MOM I ORING SYSTEM I 1 12 <br /> APPROVED MOMiOR EREOUENCY 13 14 <br /> MONITORING RECORDS MAINIAINED 15 16 <br /> ACCESS CASING SECURED 11 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 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 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 133 134 <br /> SAFETY HAZARD 35 38 <br /> CONDIT IONS ABATED 37 <br /> TEMPORARY TANK CLOSURE iTi 1 NIP <br /> REMOVAL OF RESIDUAL' W-t43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER pSCONNECTED OWNER/OPFRATOR MONITORING 1t a�i <br /> PERMANENT TXNK CLOSURE <br /> , <br /> REMOVAL OF RESIDUAL MATERIALS 48 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTI IORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANOONMENT 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 /> MNO <br /> OTOR ❑ VIOL ❑ VIOL.❑ _ _ �•T� <br /> OFFICE: INSP: .3�'.3 . PW4 " Sf, <br /> T17LE: .5r. / E,N;S. 0 G�. �/} BECK <br /> 11117-3 W l,•.OFq'nm yoOwnN i Cmv PNM.FII•COPY <br /> PHS 178 (4196) <br />