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71 <br />w. <br />*&GROUND TANK OFFICIAL INSPECTIORT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />.x ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 <br />COUNTY # <br />.�o <br />SITE NAME: <br />�a <br />� z <br />PIPING <br />48 49 <br />INSPECTION DATE: <br />50 <br />SITE ADDRESS: <br />UNAUTHORIZED RELEASE <br />+ <br />CITY/STATE/ZIP,,,,..�^''"� ,� <br />A <br />SAMPLING <br />53 54 <br />CHANGES SITE YES <br />NO <br />TANK <br />TANK <br />C_ <br />TANK <br />TANK <br />THE MARKED I..T��E.»M--S REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FORM A AND/OR B SUBMITTED? <br />FOLLOWS:_- <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />o <br />TITLE: <br />PER # <br />PER # <br />PER # <br />PER # <br />A <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />CONTENTS <br />3 > <br />MAJOR MINOR <br />" y:£, <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />__._-__,_-,�__ <br />..�_ ___.,____._ <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />/ <br />37 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 147 <br />�a <br />� z <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED I..T��E.»M--S REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:_- <br />57 58 <br />MAJOR❑VIOL, MINOVIOLR <br />R ❑ <br />59 <br />NO <br />VOL. ❑ <br />— <br />OFFICE: <br />INSP:�.N <br />RECEIVED BY: <br />TITLE: <br />PHONE: -- - - - - - - <br />RECK`- <br />