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UJIGROUND TANK OFFICIAL INSPECTION RE T <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEAL,TH DIVISION <br /> 304 E.Weber Ave.. rd Moor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME s� Stockton. 9=1.0= COUNTY #j g <br /> 3420 <br /> SITE NAME: S�'D G INSPECTION DATE: <br /> SITE ADDRESS:/ F CITY/STATE/ZIP r' <br /> CHANGES SITE/OWNER/PERMIT? YES j NO TANK $ TANK 7 TANK � TANK C� <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE COMP3R <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER � <br /> "7 4A 1` -'Q� A 3116 '5 EXPER <br /> DATE EXP. DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS rG•.� fir; r- `� ••• <br /> OPERATIONAL TANK / <br /> MAJOR MINOR ;',y ,. Q <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 /> CE SMONITORING <br /> 15 16 <br /> ACC SING SECUREDINTAINED 17 16 <br /> PIPING 19 120 <br /> :NVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIFIS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED33 34 <br /> SAFETY HAZARD 4 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE ft, <br /> fr <br /> REMOVAL OF RESIDUAL` 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> . . <br /> PERMANENT TANK CLOSURE r }�, , T <br /> 1 <br /> REMOVAL OF RESIDUAL,MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS RgMOVED 50 <br /> UNAUTHORIZED RELEASE 51 <br /> SAMPLING 53- 547 <br /> IMPROPER ABANDONMENT 55 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUSr MARK ONE) FOLLOWS <br /> _ ---- <br /> 59 <br /> MA.IOR 57 MINOR Q NO <br /> VIOL. VIOL. VIOL.LJ I- L-rj <br /> OFFICE: INSP: - � RECEIVED BY: <br /> TITLE:PPHONE: BECK: <br /> e` <br /> HUT-3 While-Original Yellow-Owner's Copy Pink-no Copv <br /> PHS 178 (4/96) <br />