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UAGROUND TANK OFFICIAL <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL <br />Address:�45 N. San Joaquin Street <br />Mailing P.O. Box 388 <br />COUNTY NAME <br />l <br />SITE NAME: <br />(I igu 4 �L/1 <br />SITE 'rim <br />CHANGES SITE /OWNER/ PERMIT? YES <br />Ofi • • <br />' !10 f ' ,fir. i • <br />NO TANK <br />COMPUTER 7 <br />NUMBER <br />PER # <br />I TANK <br />TANK CONTENTS <br />-s"- <br />TANK <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />/ <br />37 <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />TANK <br />COMPUT <br />NUMBER <br />PER # <br />EXP. DATE <br />38 39 <br />-s"- <br />TANK <br />TANK <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />38 39 <br />REMOVAL OF RESIDUAL MATERIALS <br />40 <br />_ <br />48 <br />49 <br />41 42 <br />43 <br />44 45 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />F56 <br />;YSTEM STATUS (MUST MARK ONE) <br />MAJOR 67 MINOR 58 NO <br />VIOL. ❑ VIOL. ❑ VIOL. 59 <br />rl <br />OFFICE: <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />INSP: t <br />TITLE: `- <br />)nnv Pink . Fila f`nnv <br />/ RECK: <br />