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" AGROUND TANK OFFICIAL INSPECTION RAT <br /> + SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENT�IL HEALTH DIVISION <br /> 304 E. ,LVE <br /> ber Ave., bird Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 486-3420 <br /> SITE NAME: -es <br /> C INSPECTION DATE: <br /> SITE ADDRESS: 32� (adv d CITY/STATE/ZIP q S3 (p <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK (p TANK TANK E5 -TANK Q <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER 4t NUMBER NUMBER NUMBER <br /> Q NUMBER <br /> PER If CCL_ PER# (,�� PER x �Pj—G� PER* <br /> " / t EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK rnNlc CONTENTS �� to OCA <br /> MAJOR ININOR r� .' � .±� �t� /q <br /> PERMIT 70 OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSIEM 9 IU j <br /> MONITORING SYSTEM 11 112 1 <br /> APPROVED MONITOR FREQUENCY 13 14 / <br /> MONITORING RECORDS MAINTAINED 15 I6 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> :NVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 4 23 24 <br /> APPROVED RESPONSE PLAN 25 126 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIFIS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED W37 <br /> TEMPORARY TANK CLOSURE r� � v4 1{spit w <br /> ,02 low <br /> �" .�`' > <br /> REMOVAL OF RESIDUAL' 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> t <br /> PERMANENT TANK CLOSURE �y1 ,� � � � 1�1 t„�'� � <br /> REMOVAL OF 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 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:57 58 59 <br /> — -- ------ <br /> VIOL R ❑ VIOL.R ❑ VOL.❑ -- — --... —_---- <br /> OFFICE: INSP. \�,,Uk­k RECEIV D B _ <br /> TITLE: PH BECK: <br /> HUT-3 While-Original Yellow-Owner's Copy Pink-File Copv <br /> PHS 178 (4/96) <br />