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i J J' RGSO UND TANK OFFICIAL INSPECTION T N JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street COUNTY NAME Mailing Address: P.O.Box 388 Stockton,468-3420 CA 01.0388 COUNTY # SITE NAME: INSPECTION DATE: SITE ADDRESS: >07 CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK C7 TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION NUMBER �j NUMBER NUMBER SITE COMPUTER# NUMBER PER# PER# PER# PER# EXP DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS , MAJOR MINOR `` PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION ..... ....... 5 6 WRITTEN MONITORING PROCEDURES 7 8 " APPROVED MONITORING SYSTEM g 10 MONITORING SYSTEM11 12 —___""_...__._ ....______•._,_..__,_ ......_.._._ APPROVED MONITOR FREQUENCY ..13 14 ' MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 w. - PIPING 19 20 INVENTORY RECONCILIATION 21 22 .I TANK GAUGING 23 24 __.._..._.- APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 2g ` --- " SAMPLING 29 30 ------------ --- APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD CONDITIONS ABATED 37 -""_""�"• `-------------- "'"""_ a_......,_._. . TEMPORARY TANK CLOSUREmom REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 _---------- ..............._..._...........". ,._.. �. POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 x PERMANENT TANK CLOSURE q - REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) 57 58 59 MAJOROL VIOL. —1 MINOR. ❑ VIOL.❑ -- -- — -- -- --. !i OFFICE: INSP-. RECEIVED BY: TITLE: " t1 s PHONE: f BECK: HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy�/ s�F 5/88 C�M