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�' UNDERGROUND TANK OFFICIAL INSPECTION REPORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Boz 388 <br /> COUNTY NAME Stockton.CA95201-0388 COUNTY # <br /> 468-3420 <br /> l'E NAME: �i <br /> �/� fir/ INSPECTION DATE: ]/�F n <br /> . .'.f//`fes <br /> SITE ADDRESS: J CITY/STATE/ZIP / ::;-f <br /> / <br /> /L `� 7� �f• �L�J j� YCa <br /> CHANGES SITE/OWNER/PERMIT? YES NO I TANK o I TANK OZ- TANK o'7; TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER/ate COMPUTER yak COMPUTER COMPUTER .' <br /> NUMBER NUMBER 4.PA– NUMBER e4,Ae- NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# I�if� L PER# <br /> EXP.DATE EXP,DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK-. Mruoe MrNOA <br /> ¢ x <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 X _•_ _ _ --------------- i <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 26 <br /> ACCESS CASING SECURED 17 16 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK'GAUGING 23 24 —_—��_—•--- <br /> APPROVED RESPONSE PLAN 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> RAMPUNG 29 30 ---- ------— <br /> :'ROVED TANK REPAIRS t 31 <br /> UNAUTHORIZED RELEASES REPORTED. 33 34 <br /> --SAFETY HAZARD 35 jw <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 43 — _—...._____.___.-•___._.______._.- <br /> I DOWNER/OPERATOR MONITORING 144 45 <br /> s <br /> PERMANENT TANK CLOSUREat <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 <br /> k FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS{MUST MARK ONE) FOLLOWS:MAJO <br /> 57 58 59 <br /> Mil <br /> VIOL. <br /> VIO." ❑ VOL❑ <br /> { <br /> OFFICE: INSP-. ya�G RECEIVED BY: <br /> TITLE: ���� PHONEBECK: <br /> 5/8a •�M. <br /> 1 NUT-3 White-Original Yellow-Owner's Copy Pink-Fire Copv <br />