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UND'i%.d'ROUND TANK OFFICIAL INSPECTION REPe101- <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N,San Joequin Street <br /> Mailing Address: P,O,Box 388 <br /> COUNTY NAME F Stockton,CA 95201-0388 COUNTY # <br /> 59 <br /> hAt 468,3420SITE NAME: � I � INSPECTION DATE:_ 4 <br /> SITE ADDRESS: ! QHA F-+ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? NO TANK Ql TANK TANK 03 TANK �- <br /> FORM A AND/OR B SUBMITTED? COMPUTER , �� COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER 0 NUMBER !� NUMBER <br /> TY <br /> OF INSPECTION S # <br /> ITE COMPUTER PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK rANK CONTENTS <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 /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 mm <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 45� - <br /> 2 <br /> SAMPLING 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED TEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS{MUST MARK ONE} 'r <br /> FOLLOWS: _..- <br /> MAJOR 57 MINOR 58 NO 59 i — i.= J <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: f'�_t RECEIVED BY: <br /> TITLEC��,v � PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv 5/88 0- <br />