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UN GROUND TANK OFFICIAL INSPECTION R <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 <br />SITE NAME: <br />SITE ADDRESS: 9 1 CITY/STATE/ZIP <br />dPXW_ ad I <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK <br />COMPUTE <br />NUMBER <br />TANK .<—::Z <br />COMPUTER <br />NUMBER <br />TANKTANK <br />COMPUTE 51 <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE TCOMPUTER # <br />I I A <br />REMOVAL OF RESIDUAL 38 39 <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />TI AL TANK <br />PERMIT TO OPERATE <br />TANK CONTENTS <br />ACCESS LOCATIONS SEALED 41 42 <br />UNAUTHORIZED RELEASE <br />MAJOR MINOR <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />OWNER/OPERATOR MONITORING 44 45 7 <br />3 4 <br />APPROVED CONSTRUCTION <br />IMPROPER ABANDONMENT <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />THE MARKED ITEMS REPRESENT <br />FOLLOWS: 7ra64: <br />f- <br />VIOLATIONS AND MUST BE CORRECTED AS <br />;YSTEM STATUS (MUST MARK ONE) <br />9 10 <br />MONITORING SYSTEM <br />57 58 <br />MAJOR MINOR No <br />VIOL. R - VIOL� El VOL.' <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />c% <br />v <br />13 14 <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 />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />--- -------- <br />SAMPLING <br />29 130 <br />APPROVED TANK REPAIRS <br />31 32 <br />. . ...... <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />W <br />47 <br />g m <br />gm, <br />PIPING <br />48 <br />REMOVAL OF RESIDUAL 38 39 <br />FLAMMABLE VAPORS REMOVED 42-- mm <br />50 <br />m <br />ACCESS LOCATIONS SEALED 41 42 <br />UNAUTHORIZED RELEASE <br />51 <br />POWER DISCONNECTED M43 <br />OWNER/OPERATOR MONITORING 44 45 7 <br />153 <br />154 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />g m <br />gm, <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />m <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />153 <br />154 <br />IMPROPER ABANDONMENT <br />155 <br />56 <br />THE MARKED ITEMS REPRESENT <br />FOLLOWS: 7ra64: <br />f- <br />VIOLATIONS AND MUST BE CORRECTED AS <br />;YSTEM STATUS (MUST MARK ONE) <br />57 58 <br />MAJOR MINOR No <br />VIOL. R - VIOL� El VOL.' <br />59 <br />Z <br />c% <br />v <br />X2121 <br />TITLE: R, e fj_:5. PHONE: <br />NE: TECK: <br />HUT®3 White-Orlainal Yellow -Owner's copy Pink - File Conv <br />