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SRGROUND TANK OFFICIAL INSPECTION R&T <br />SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENT41- HEALTH DIVISION <br />304 E. eber Ave., Third Floor <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 COUNTY # <br />"9.3420 <br />SITE NAME: CAL-19-�(,;k CC-) <br />INSPECTION DATE: 1/4/Q-4 <br />SITE ADDRESS:JI/� MUS��(� /� <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER//PERMIT? YES <br />NO <br />TANK711f6gZ 0( <br />TANK 7A (j©CIZOZ <br />TANK 7A J4,gZC)3 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER* Q1 T <br />NUMBER <br />PER # u/ <br />NUMBER <br />PER # ':1)! C <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER f <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />TANK CONTENTS <br />OPERATIONAL TANK <br />qty <br />MAJOR MINOR <br />(: t t <br />i. ... <br />PERMIT 70 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 SYSIEM 9 <br />IU <br />112 <br />JS, j <br />/�S <br />MONITORING SYSTEM 1 I <br />ciiQ" <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />C� J <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 135 <br />136 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />OEM <br />1 baf�s . <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ME <br />ACCESS LOCATIONS SEALED 41 <br />42 <br />POWER DISCONNECTED <br />4:3�] <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:57 <br />— <br />--- ------ <br />58 59 <br />— <br />-- — --- <br />MAJOR❑ MINOR❑ NO <br />❑ <br />_-- <br />VIOLVOL. <br />VIOL. <br />— <br />-- <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />HUT -3 White - Original Yetlow - Owner's Copy Pink - File Copv <br />PHS 178 (4/96) <br />