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ND TANK <br /> FFICIAL <br /> UNLSAND OAQUIN PUOBLIIC HEALTH SERVICOESREt•� <br /> ENVIRONMENTAL HEALTH DIVISION Z <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201.0388 COUNTY # l% <br /> 468-3420 <br /> SITE NAME: i �Ll INSPECTION DATE: 2,7--qSITE ADDRESS: h f0 CITY/STATE/ZIP Gg�? <br /> ,,) <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK �2 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> NUMBE-tO/`}`� NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # �vw�"' PER # PER # PER # <br /> EXP.DAT 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 18 <br /> APPROVED MONITORING SYSTEM 9 110 <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 114 <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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL &44 <br /> t145 <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 V OLATIONS AND MU T BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLO S: v 00 <br /> 57 58 59 <br /> - <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. — -- <br /> OFFICE. INSP: rte,.. RECEIVED BY: <br /> TITLE:�� � PHONE: BECK: <br /> U <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv ""' <br />