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U. GROUND TANK OFFICIAL INSPECTION R.�T <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing tAddress: P.O.Boz 386 3/�"'//// <br /> COUNTY NAME SlocMon,on,CA95201-0388 <br /> 466-9420 COUNTY # <br /> SITE NAME: --r INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE IP <br /> v <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TAIK TANK TANK <br /> FORM A AND/OR B SUBMITTED? NUMBECOMPUTERVOI/�(7 COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# / <br /> y, PER# ``� 1NUMBER NUMBER NUMBER <br /> � <br /> PER# PER # PER# <br /> - <br /> alsi U EXP.DAT EJf" EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 8 <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 <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 33 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE " <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <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 REPRESENT VIOLATIONS AND MUST BE CORK T ❑ S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: '� u I ) <br /> A58 <br /> i <br /> MAJOR 57 MINOR NO �591 <br /> VIOL. ❑ VIOL. ❑ VIOL.ILT' <br /> I <br /> OFFICE: INSP`.�/ rr✓Ld 7 RECEIVED BY: <br /> TITLE:S � / PHONE: BECK: <br />