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UN IIIIIIIIIII(OUND TANK OFFICIAL INSPECTION RE[ <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Tnird Floor <br /> Mailing Address:P.O.Box 366 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: c, K L&Af&— INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? 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 A PER # PER # PER <br /> r EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS ANf' <br /> OPERATIONAL TANK <br /> MA ' <br /> JOR 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 SYS]EM 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 38 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE ®rilltl <br /> Rai, fM r ipo- -.4 <br /> REMOVAL OF RESIDUAL 38 39 - <br /> FLAMMABLE VAPORS REMOVED 40 ME <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED BE 43 <br /> OWNER/OPERATOR MONITORING 44 145 <br /> 111 NO <br /> PERMANENT TANK CLOSURE ; . `1` t +%{til,tI- .. :'t �.. 14, <br /> REMOVAL OF RESIDUAL MATERIALS" 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED `� <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND FAUST BE CORRECTED A� <br /> SYSTEM STATUS(MUSE MARK ONE) FO58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL• ❑ VIOL. VIOL.❑ <br /> OFFICE: IN <br /> SP: RECEIVE BY: <br /> TITLE: <br /> PHONE: BECK: <br /> 1-IUT-3 While-Original Yellow-Owner's Copy Pink File Copv PHS 178 (4/96) <br />