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i <br /> LIARGROUND TANK OFFICIAL INSPECTION RE T i <br /> a SAN JOAQUIN PUBLIC HEALTH SERVICES - <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor d j <br /> r. Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton.468Q95201-0388 COUNTY <br /> ir <br /> SITE NAME: INSPECTION DATE: <br /> 7 <br /> SITE ADDRESS: 3 Z Zr t 1 , CITY/STATE/ZIP j <br /> CHANGES SITE YES NO TANK i, / : TANK y TANK5 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER / COMPUTER COMPUTE COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER/I NUMBER ,q/M NUMBER ,��} NUMBER <br /> PER .e /a/� PER ,t V PER PER ;e <br /> L EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK -Morn COrnerns i;!1 1i rr�; +! ,r _ ( �� <br /> IVIAJOFi MINOR ..�'-� .t..-•- - ""`� <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 SY51EM 9 ve IU ' -1/- <br /> MONITORING SYSTEM 11 12 a ' <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> '.i MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> V" .._ <br /> !NVENTORY RECONCILIATION 21 22 1� <br /> TANK GAUGING 23 24 f <br /> APPROVED RESPONSE PLAN 25 26 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> I SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 ;?d <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE a<. r =i '' <br /> REMOVAL OF RESIDUAL` 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 y <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> �1k� 3Tn.q <br /> .. IMT, a,•1L CR 1'h� RnS .r,1 rFn .' , ✓1.s �.1,. 1 <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 r <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 :p <br /> ' 57 58 59 CATNA <br /> MAJOR MINOR NO , <br /> VIOL I f VIOL. ❑ VIOL.❑ — — <br /> - i <br /> OFFICE: INS�PI_: Q � ,OZ RECEIV D BY: " <br /> TITLE: � q RE,K: <br /> HUT-3 White-Original Yellow•Owner's Copy Pink-File Capv <br /> A '� PHS 178 (4196) <br /> r 'i� <br />