Laserfiche WebLink
Uhv "RGROUND TANK OFFICIAL INSPECTION REPORT <br /> " SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: J I INSPECTION DATE: <br /> SITE ADDRESS: N <br /> %,/ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NOTANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER <br /> PER 9 PER+t PER N PER <br /> EXP.DAIE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS �,.' a r,.; a� j 1i P1, <br /> { } <br /> MAJOR IMINOR j n f fr <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCT ION 5 611 I tel/ <br /> WRITTEN MONITORING PROCEDURESAI 7 8 015, (�`If <br /> APPROVED MONITORING SYSTEM IV 9 10 <br /> MONITORING SYSTEM 1 I 12 �"1 l v/(7 r7 Jai I (/ / n <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> NVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 2 / Z ?✓- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 !• / I: �A �, 5-/1 <br /> SAMPLING 29 30 I 5-D4 t4'I/ <br /> APPROVED TANK REPAIFJS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY I1AZARD ` 35 136 <br /> CONDITIONS ABATED 37 <br /> rt <br /> TEMPORARY TANK CLOSURE vn , <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 /> PERMANENT TANK CLOSURE � i ;�t <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:57 58 59 <br /> -- -------- <br /> MAJOR ❑ MINORVIOL. ❑ No <br /> VIOL.❑ _ — -- —_ _ - -- <br /> VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink•File Copv <br /> PHS 178 (4/96) <br />