Laserfiche WebLink
U1. AGROUND TANK OFFICIAL INSPECTION RE IT <br /> • SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 r <br /> SITE NAME: v � �` M INSPECTION DATE: 12/I IN2 <br /> SITE ADDRESS: CITY/STATE/ZIP - <br /> CHANGES SITE YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER # PER N PER* PER N PER <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS :'` <br /> MAJOR MINOTi <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 SYS IEM 9 10 <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 /> ;NVENTORY 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 REPAIFJS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY I IAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> • <br /> TEMPORARY TANK CLOSURE ' ar , 1 ' `�� ' ,4 '4'r;• ii ' i•': <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 CLOSURE1 # <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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:—s3-�-�► -- ------ <br /> MAJOR <br /> J R D MINOR58 <br /> No [59 — _—— --- - -- <br /> IO <br /> OFFICE: INSP RECEIVED <br /> PHONE BECK: <br /> FIUT-3 While•Original Yellow-Owner's Copy Pink--File Copv <br /> PHS 178 (4/96) <br />