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Uh'%mAGROUND TANK OFFICIAL INSPECTION RL-IRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,68 342001-0388 COUNTY # 3� <br /> SITE NAME: / INSPECTION DATE: <br /> 1 <br /> � <br /> SITE ADDRESS: ^^ ^ _ N CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK \ ANK TANK ANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER 1 COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> �?�{N- �j �� PER# PER# PER # PER# <br /> ?�.iC <br /> /YlEXP.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 8 <br /> APPROVED MONITORING SYSTEM 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 /> 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/OPERATOR MONITORING 44 45 - <br /> PERMANENT TANK CLOSURE <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 155 156 <br /> THE MARKED ITEMS REPRESET VIOLATIONS AND MUST BE CORREC ED AS <br /> SYSTEM STATUS(MUST MARK ONE) I �yr4L�`�� <br /> FOLLOWS:57 58 <br /> MAJOVIOL.R ❑ MINOVIOL.R ElVNO <br /> IOL. 59 <br /> OFFICE: INSP: 1,� RECEIVED BY., <br /> TITLE: j�� PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv 5/88 �" <br />