Laserfiche WebLink
1 <br /> U3GROUND TANK OFFICIAL INSPECTION R _ jRT <br /> SAN JOAQUIN PUBLIC HEA1:rH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.B z 388 <br /> COUNTY NAME� J�'� �r Stockton.ha 3420 1 a ea COUNTY #3 <br /> SITE NAME INSPECTION DATE:55~3!- 4 <br /> SITE ADDRESS: 3 j �1,� `' CITY/STATE/ZIP <br /> N, <br /> `' i'i� �iU -S Ci A�t1 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK '— TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> PER # PER# PER# PER# <br /> a 3 <br /> EXP.DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK Tnrtx corrrENTse9® <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 B <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 5. - -.-...._ <br /> S-a i:.n <br /> PIPING 19 20 � .. 154. Ae <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> ------.._.-. ...... <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 132 <br /> _.._.-.... - — - _..,-... .........- <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 ITEMS F EPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOL DWS: ` ` <br /> 57 58 59a , - <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: <br /> TITLE^ �}` j��.; ( PWI E: �� RECK: <br /> HLIT-3 '• Me-Orginal 'fellow-Owner's CORY Pink-;Ne Capv <br />