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U4kRGROUND TANK OFFICIAL INSPECTION FORT <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, CA 95201-0388 <br />468-3420 COUNTY # <br />SITE NAME: dna INSPECTION DATE: <br />SITE ADDRESS: L)e s�- L, ,e CITY/STATE/ZIP 5AZIC /k� <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />NUMBER <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />OPERATIONAL TANK <br />TANK CONTE NTS <br />MAJOR MINOR <br />42 <br />FLAMMABLE VAPORS REMOVED 50 ME <br />'A <br />1 2 <br />43 <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />44 <br />-45 <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />57 <br />57 59 <br />58 <br />MAJOR MINOR <br />❑n E] No [ <br />❑VIOL. <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />- - -- <br />-- ------ <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />- -- --- ------- - <br />...... <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />§ gg <br />ON R <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />PIPING 48 49 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />FLAMMABLE VAPORS REMOVED 50 ME <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />-45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />PIPING 48 49 <br />FLAMMABLE VAPORS REMOVED 50 ME <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 153 154 <br />IMPROPER ABANDONMENT 155 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS:— Aleli7k-d 4�.k <br />SYSTEM STATUS (MUST MARK ONE) <br />57 <br />57 59 <br />58 <br />MAJOR MINOR <br />❑n E] No [ <br />❑VIOL. <br />VIOL. VIOL. <br />OFFICE: INSP: <br />TITLE: <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />5/88 0 <br />