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CHANGE IN CONDITIONS TO OPERATE 3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />REMOVALOF RESIDUAL <br />U GROUND TANK OFFICIAL INSPECTION T <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />=m <br />APPROVED MONITORING SYSTEM <br />ENVIRONMENTAL HEALTH DIVISION <br />OWNER/OPERATOR MONITORING <br />- - <br />445 N. San Joaquin Street <br />11 12 <br />COUNTY NAME Q <br />Mailing ckto 4 2901-0388 88 <br />Stockton, <br />COUNTY <br />� <br />8CA 34 <br />13 14�� <br />SITE NAME:(vt <br />L ::::� Ljj <br />INSPECTION DATE:'_ J <br />15 16 <br />ACCESS CASING SECURED <br />SITE ADDRESS: 2 <br />CITY/STATE/ZIP <br />S <br />CHANGES SITE/OWNER//PERMIT? <br />YES No <br />ITANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />TANK GAUGING <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INVECTION <br />SITE COMPUTER # <br />'v3�® <br />ZO <br />27 28 <br />PER # <br />PER # <br />PER # <br />PER # <br />APPROVED TANK REPAIRS <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />TANK <br />TANK <br />NK conrrENrs'a <br />3r <br />b,. <br />MAJOR MINOR'o. <br />37 <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE 3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />REMOVALOF RESIDUAL <br />REMOVAL OF RESIDUAL MATERIALS <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />ACCESS LOCATIONS SEALED <br />=m <br />APPROVED MONITORING SYSTEM <br />w _e <br />OWNER/OPERATOR MONITORING <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />SAMPLING <br />53 <br />APPROVED MONITOR FREQUENCY <br />� <br />55 <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 />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 134 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY <br />REMOVALOF RESIDUAL <br />REMOVAL OF RESIDUAL MATERIALS <br />VAPORSFLAMMABLE • • <br />F <br />ACCESS LOCATIONS SEALED <br />=m <br />POWER DISCONNECTED <br />50 <br />OWNER/OPERATOR MONITORING <br />UNAUTHORIZED RELEASE <br />PERMANENT TANK CLOSURE <br />MAJOR 57 MINOR 58 <br />VIOL. ❑ VIOL. ❑ <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />s <br />6 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 <br />VIOL. ❑ VIOL. ❑ <br />NO 59 <br />VIOL. <br />OFFICE: <br />INSP- <br />s <br />6 <br />TITLE: c <br />THE MARKED IT S REPRESENT VIOLATIONS AND MUST BE <br />FOLLOWS:—�_� C O N N4 LS hQ <br />RECEIVED BY: <br />r746 <br />OWS PHONE: <br />AS <br />