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UNWGROUND TANK OFFICIAL INSPECTION REPORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME MaStockton.CA 95201-0388 iling Address� P.O.Box 88 <br /> 468.3420COUNTY # <br /> SITE NAME: D INSPECTION DATE: <br /> SITE ADDRESS: ;,7000 CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? Y S NO TANK TANK` TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIO SITE COMPUTER# NUMBER Q NUMBER ®� NUMBER NUMBER <br /> �J-� 7 PER# PER#,: ,/ PER# PER# <br /> r !r EXP.DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS ypy.: < <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _..... -.._.. <br /> APPROVED CONSTRUCTION5 6 <br /> WRITTEN MONITORING PROCEDURES 7 s ,-----_------- <br /> ... _._..,._.._..__.....___. <br /> APPROVED MONITORING SYSTEM 9 110 - :_____.__.._...__.•_. -_..,___.____.,... ,.._.._.._...... . _ .._...__....... ...... <br /> MONITORING SYSTEM 11 12 <br /> -------- <br /> ._.................. <br /> -------- <br /> ...._------------ <br /> :...._____......-. ,_._._.._...._._....._:..... .... ..._..,._._ _. <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 _.._...._.__._,.... . .........__. ..,. -.. ._. _------ <br /> ACCESS CASING SECURED17 18 ...... <br /> - <br /> PIPING <br /> 19 2p <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 ------- _--_....__. .----...------...__........ ......... ..._. _....-- <br /> w_ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> ........... �.__.-- _ -------__.__.,.------___.._.__. <br /> SAMPLING - :. ....��-.._.._.-_. _....._.._._,-_ <br /> APPROVED TANK REPAIRS37 . 32 --- - ------ ___._. .....m,..__..._..__,.,_ ._. __':....__...•_. _ <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 - <br /> CONDITIONS ABATED 37 <br /> ---------------------- <br /> TEMPORARY <br /> ____..-_.....------TEMPORARY TANK CLOSURE <br /> NO Q <br /> REMOVAL OF RESIDUAL 38 39 <br /> _...... . <br /> �I FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 - <br /> OWNER/OPERATOR MONITORING 45 <br /> PERMANENT TANK CLOSUR wll ��, � R <br /> REM RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 _.............. <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE► <br /> FOLLOWS: <br /> MAJOR 57 MINOR58 NO 59 066r <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> r <br /> f <br /> TITLE' PHONE: BECK: <br /> I ALIT—:1 White-Oricinal Yellnw-nwnmr'c P.,,.,., mi-I �._ <br />