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Uf RGROUND TANK OFFICIAL INSPECTION R, SRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N San Joaquin Street <br /> Mail Ag Address P 0 Box 388 <br /> COUNTY NAME Stockto a s sato 1 0388 COUNTY # <br /> E NAME <br /> INSPECTION DATE <br /> ITE ADDRESS CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK TANK TANK TANK <br /> ORM A AND/OR B SUBMITTED9 COMPUTER COMPUTER COMPUTER COMPUTER <br /> YPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br /> PER # PER # PER # PER # <br /> EXP DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS royr , <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 /> ONITORING SYSTEM 11 12 <br /> PPROVED MONITOR FREQUENCY 13 14 <br /> ONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> IPING 19 20 <br /> NVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> PROVED RESPONSE PLAN 25 26 <br /> NAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 2y FE - <br /> ROVED TANK REPAISRS 31 32 <br /> THORIZED RELEASES REPORTED 33 34 <br /> TY HAZARD 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> EMOVAL OF RESIDUAL 3g 39 <br /> LAMMABLE VAPORS REMOVED 40 <br /> CCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> WNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> IMOVAL OF RESIDUAL MATERIALS 46 47 F <br /> PING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> ff, UTHORIZED RELEASE 51 52 <br /> WMPLING 53 54 <br /> IMPROPER ABANDONMENT 5,5 56 <br /> THE MARKED ITEMS REPRESENT VI ATIONS AND MUST BE CORRECTED AS <br /> TEM STATUS{MUST MARK ONE) <br /> FOLLOWS <br /> 57 58 59 <br /> IONO <br /> LORMIN❑ VIOLOR ❑ VIOL ❑ -- <br /> _ t>p <br /> ICE INSP RECEIVE Y <br /> TITLE 'V�7 4-_'S NE RECK <br /> -3 White Original Yellow Owner's Copy Pink File Copy <br />