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Uf k4OUND TANK OFFICIAL INSPECTION RE Imo/ <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HI A TH DIVISION <br /> 304 E. ober Ave., hird Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 96201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: , INSPECTION DATE: VZ117 <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 fpER# PER# PER * PER x <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR y ` r <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)<r14 <br /> MONITORING RECORDS MAINTAINED 157 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> - <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 33 134 <br /> SAFETY HAZARD35 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 m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> �,` a <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 MR <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIO S AND MUST BE CORRECTED AS. <br /> 70 <br /> SYSTEM STATUS IMUST MARK ONE) FOLLOWS ------- <br /> 57 58 59 <br /> No <br /> VIOL..MAJOR ❑ VIOL..R ❑ VOL.❑ — -- <br /> OFFICE: INS RECEIVED BY: <br /> TITLE:�z � PHON BECK: <br /> 3 5 <br /> HUT-3 While-Original Yellow-Owner's Copy Pink-File Copv <br /> PHS 178 (4196) <br />