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L :RGROUND TANK OFFICIAL INSPECTION I, .IRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME MailinStockton,rCA 95201-0388388 201038888 <br /> 468-3420 COUNTY # <br /> SITE NAME �— <br /> L_ l �,x�L� INSPECTION DATE:Z / g <br /> SITE ADDRESS: q4�o �Y lQ�� ��" \ t CITY/STATE/ZIP gt�Gk�ov, <br /> CHANGES SITE/OWNER/PERMIT? YES Y 1 NO TANK'�\OsS y TANK IUSSCj74 TANK IOSSUS TANK tc25�ooj <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> `� _ PER#�I�Se` PER # ��p PER# L,L� PER# UL <br /> �V��" EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> BITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 � cLso�.l. <br /> �l <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 <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 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 <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 /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE ' dx <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 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR ❑ MINOR <br /> ❑ NO <br /> VOL.❑ — ----— - —- <br /> VIOL- <br /> VIOL <br /> OFFICE: INSP: � `/ RECEIVED Y: <br /> \)vS H IOKA <br /> TITLE: 'RE l I S PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy oink-File Copy H <br />