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UOGROUND TANK OFFICIAL INSPECTION R& <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor <br /> Mailing Address:P.O.Boz 3sa <br /> COUNTY NAME Stockton.Casio 1.-03Ba COUNTY # <br /> FSITENAME: <br /> Y'�D� INSPECTIONDATE:ADDRESS: G� CITY/STATE/ZIP GES SITE/OWNER/PERMIT? YES NO TANK J TANK x1 Z_. =DATEEXP. <br /> A AND/OR B SUBMITTED? COMPUTER/BER K COMPUTER/p� UTE /�_� aF INSPECTION SITE COMPUTER+F NUMBER ERO'Zi(�t PER f PER/ <br /> EXP DATE EXP DATE OPERATIONAL TANK TANK COMENMATE <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 IO <br /> MONITORING SYSTEM ll 12 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 is - - <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 2I 22 - - <br /> TANK GAUGING 23 24 ---- -- - - <br /> APPROVED RESPONSE PLAN 25 26 - <br /> - <br /> UNAUTHORIZEDRELEASEOCCURRENCE 27 28 -- - - <br /> SAMPLING 29 30 <br /> ....____....... ...... ...... .... <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 - <br /> TEMPORARY TANK CLOSURE • 2• �.T �s t t I ti r4rhs s� <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 /> ERMAT]ENT TANK CLOSURE � w • ' r � � ` :�J ,r' + ' <br /> q vel CIF R ID TAI �TERIALS 46 47 <br /> PIPING q8 qg <br /> FLAMMABLE VAPORS REMOVED 50 - <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLq/TIONS AND FAUST <br /> BE CORRECTED AS <br /> SYSTEM STATUS IMUSf MARK—ONE) FOLLOWS: :5aGL/ Lt./Yf <br /> VIOL. 57 68 NO 59 <br /> OR ❑ VIOLQ.R ❑ VOL.❑ <br /> OFFICE: INSP: � G RECEIVED BY: <br /> TITLE: �•�.�� PHONE: BECK: <br /> HUT-3 While-Original Yellow-Owners Copy Pink-File Copv <br /> PHS 178 (4196) <br />