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Y-7 0-7 _ .. <br /> UGROUND TANK OFFICIAL INSPECTION 41�AT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> f• <br /> COUNTY NAME Mailing Address: P.O.Box 388 <br /> Stockton.ss acrinol ossa COUNTY # <br /> SITE NAME: n INSPECTION DATE: a_7 ylc/ <br /> SITE ADDRESS: yr <br /> W r�� Ci7Y/STATE/Z!P <br /> f,� /__ - '/�n <br /> CHANGES SITE/OWNER/PERMIT? YES /N0 TANK TANK Z TANK TANK <br /> FORM A AND/OR B SUBMrTTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBERPER# PER# PER # PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK 'TANK coNrennsi /}`ry'��y � :+ ,� , t .,( rD= , F � �. `,,• <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 .._._ <br /> APPROVED CONSTRUCTION 5 fi --- --—- - ---- - --- -_ --•---- -•- _--- <br /> WRITTEN MONITORING PROCEDURES 7 8 ---- --- - - - -- ---- <br /> APPROVED MONITORING SYSTEM 9 10 - - - - <br /> MONITORING SYSTEM 11 12 � w_ - <br /> APPROVED MONITOR FREQUENCY 13 14 - <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> ACCESS CASING SECURED 17. 18 �— M -�----�------ - - <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 22 - - ---- -w <br /> TANK GAUGING 23 24 - Y - <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 --- <br /> APPROVED TANK REPAIRS 31 ja2 - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 --- - -- W -- ------ -- - <br /> SAFETY HAZARD 35 36 _.�...... .-.............W.-._.._. _.....-.._._____._----- ----CONDITIONS ABATED ABATED 37 "-._'-. ------------------ .._.-........_..____.._.... w_._-. .., - . -.--.•- <br /> I <br /> TEMPORARY TANK CLOSURE . <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 m <br /> �"_ ____._.___._�________-- _-• --...._.__. ,_ ,w-_ ...-____ ..:._.........� <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M43 .� --—�� - ~ ---------- ---- TT - <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> 3 #�ra�it <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 56 ---�---�--------•--- ---��_--�.. -.— - -..--.. <br /> r THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONES FOLL W5- <br /> iS <br /> 58 <br /> MAJOR 57 MINOR NO j"59 <br /> VIOL LiVIOL ❑ VIOI <br /> OFFICE: INSP: REC LVED /] <br /> TITLE. E: BECK: <br /> IT—.4 White-Orininal Yellow-Owner's Coov Pink-File CODV 0µ <br />