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U GROUND TANK OFFICIAL INSPECTION R T <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME Mailing Address: P.Q.Box 388 COUNTY # <br /> Stockton,CA 95201-0388 <br /> 468-3420 <br /> SITE NAME: A INSPECTION DATE: <br /> r <br /> SITE ADDRESS: CIT /STATE/ZIP , <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKTANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER 9 COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER 20 6'0 NUMBER NUMBER <br /> PER# j PER# < PER# / PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS '� 'r �+� ,��F p°' �' c xa i '� �ccyc s y.a <br /> OPERATIONAL TAN � ,AF �� �X <br /> MAJOR MINOR r3 c'} `^-v$a,' �,.. <br /> PERMIT TO 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 SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> ------------- <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE � 3� <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:d <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 i54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: J <br /> MAJOR 57 MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> 41 �- lillz-vu Z( A -- <br /> TITLE: %ONr. REN: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/88 0 M <br />