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UV .AGROUND TANK OFFICIAL INSPECTION R. RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 3 y <br /> COUNTY NAME Stockton,CAs5201-0388 COUNTY OUNTY # <br /> SITE NAME: 7- INSPECTION DATE: _ <br /> SITE ADDRESS: Q' r L CITY/STATE/ZIP S <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK -L TANK 3TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTION SITE COMPUTER# NUMBE. , 0 NUMBERo Q&) NUMB F j/) �(� NUMBER <br /> -7 PER # �i[j PER# ,(JJ PER#' `+ ER # <br /> 6 147 A,1f ✓ EXP.DATE EXP.DATE E <br /> EXP.DATDATE <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 T �- <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 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 M43 _ <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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: A Ar <br /> 57 58 <br /> MAJOR MINOR NO 9 � <br /> eO <br /> VIOL. ❑ VIOL. ❑ VIOL.X` 1 <br /> Ai Q)) <br /> OFFICE: INSP�1 RECED Y: <br /> r <br /> TITLE: W / — O �� BECK: <br /> HUT-3 White-Original 1� Yellow-Owner's Copy Pink-File Copv 5/88 O M <br />