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U. AGROUND TANK OFFICIAL INSPECTION R, *,.�T <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaq[rin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME , Stockton,8CA <br /> 3azo01-0388 COUNTY # <br /> SITE NAME: [ / I <br /> V( / z. , c,w INSPECTION DATE: <br /> SITE ADDRESS: r <br /> CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO1 TANK (� TANK C� TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEF� / COMPUTER COMPUTER COMPUTER <br /> TYPE E INSPE( SiZ / �E PER NUMBER/`&Z PER B#E �1 v PER NUMR NUMBER PNUM <br /> ER BER <br /> EXP.DATE 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 S <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 f j <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 38 39 ! <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATO I 44 45 <br /> ERMANENT TANK CLOSURE <br /> RERIALS r5,3 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 52 <br /> SAMPLING 54 <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) / FOLLOWS: <br /> 57 58 59 �•/ f Uva. i'1.Lc.� ,2� � {�_.�� <br /> MAJOR ❑ MINOR ❑ NO <br /> VIOL, VIOL. VIOL. <br /> OFFICE: fNSP: j _f3EGEWED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />