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4 ARGROUND TANK OFFICIAL INSPECTION ART <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />4 '' ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 COUNTY # <br />ean_�e�n <br />SITE NAME: S i <br />INSPECTION DATEI 7.,-/ <br />/ <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />CHANGES SITE YES <br />NO <br />TANK .0 ?13 <br />TANK <br />TANK -:3 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBED <br />PER /076D <br />COMPUTER <br />NUMBER 1 <br />/ <br />COMPUTER <br />NUMBER/ 61fp <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br /># <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />TANK CONTENTS <br />OP RATIONAL TANK <br />- .x ae N <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />18 <br />PIPING 19 <br />20 <br />INVENTORY RECONCILIATION 21 <br />22 <br />TANK GAUGING 23 <br />24" <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35 <br />136 <br />CONDITIONS ABATED r37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 3839 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 <br />42 <br />POWER DISCONNECTED = <br />43 <br />OWNER/OPERATOR MONITORING 44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52 <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />MAJOR❑VIOL. MINVIOOR ❑ ❑ <br />VOL. <br />OFFICE: <br />INSP: � <br />RECEIVED BY: <br />/ <br />Gw"1 dii <br />TITLE: <br />PHONE: <br />BECK: <br />