Laserfiche WebLink
GRAM OFFICIAL <br /> UNDERGROUP'" TANJOPAQUI HEALTH DISTRICT <br /> r ��"'" n�-� <br /> �•• <br /> 4i.A 1601 E. HAZELTON AVE. .+" COUNTY # <br /> STOCKTON, CA 95205 33 <br /> COUNTY NAME � 1(1PHONE NO. 468-3423 r <br /> v �- INSPECTION DATE: <br /> SITE NAME: ° <br /> CITY/STATE/ZIP Cfq <br /> SITE ADDRESS: a <br /> TANK <br /> NK a TANK <br /> GNANGES SITE/OWNER/PERMIT? YES NO TANK C� / NUMBER <br /> OMPUTER OMPUTER COMPUTER COMPUTER <br /> FORM A AND/OR B SUBMITTED? UMBER UMBER NUMBER <br /> 3�� PER# PER# <br /> TYPE OF INSPECTION SITE COMPUTER 0 P R # P R # <br /> 1 3 / E DATE E DATE EXP.DATE EXP.DATE <br /> 1 TANK CONTENTS <br /> OPERATIONAL TANK 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 8 <br /> APPROVED MONITORING SYSTEM 9 10 -- - -- <br /> _. _.. . <br /> MONITORING SYSTEM 11 12 - -- <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 19 2� f at) _ <br /> PIPING jj 1! _ <br /> INVENTORY RECONCILIATION 21 22 <br /> 23 24 <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN 25 28 <br /> UNAUTHORIZED RELEASE OCCURRENCE 29 28 <br /> 1 <br /> SAMPLING 31 32 <br /> APPROVED TANK REPAIRS 33 34 <br /> UNAUTHORIZED RELEASES REPORTED 35 36 <br /> SAFETY HAZARD 37 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL <br /> 38 39 <br /> FLAMMABLE VAPORS REMOVED 4041 42 <br /> ACCESS LOCATIONS SEALED 43 <br /> POWER DISCONNECTED 44 45 <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 4748 49 <br /> PIPING <br /> 50 I <br /> FLAMMABLE VAPORS REMOVED 51 52 I <br /> UNAUTHORIZED RELEASE <br /> 53 54 <br /> SAMPLING 55 56 <br /> IMPROPER ABANDONMENT THE MARKED IT�MS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR ❑ MINOR ❑ NO <br /> VIOL. VIOL. VIOL.❑ <br /> INSP- �_ > RECEIVED BY: <br /> OFFICE: QQ <br /> TITLE: % ' "� PHONE: <br /> O iGINAL <br /> AUT-3 <br />