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UCtRGROUND TANK OFFICIAL INSPECTION F RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.Sen Joaquin Street <br /> Malting Address: P.O.Box 388 q <br /> COUNTY NAME�S� �O ,BGG%YL.% Stockton,C 952 1-0388 COUNTY #3 1 <br /> SITE NAME: 114 e INSPECTION DATE: f j ` - 1 f <br /> SITE ADDRESS: f �( G�toP.;E- CITY/STATE/ZIP ,_S �C,4,1 <br /> CHANGES SITE/OWNER/PERMIT? - YES NO TANK 1 TANK TANK TANK. <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPE(;TION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> (meg PER# PER# PER # PER # <br /> �� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS . 5 <br /> MAJOR MINOR4�. <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 — <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 T <br /> APPROVED MONITOR FREOUENCY 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 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 — �- <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE £� <br /> r <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 - <br /> ACCESS LOCATIONS SEALED 41 42 �� W <br /> POWER DISCONNECTED 43 _OWNER/OPERATOR MONITORING 44 45 - <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 - <br /> FLAMMABLE VAPORS REMOVED 50mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 156 1 - <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST RE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FO OWS: 3_0-F 4 <br /> 11 `3S <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: INSP: � t• RECEIVED BY: I <br /> U� <br /> it I <br /> r <br /> TITLE:"-) l ({ ht�- PHONE.�Z ?� 1(9 BECK: - <br /> ok rJ � � <br /> HUT-3 White-Original Yellow•Owner's Copy Pink-Ole Copv <br />