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U&GROUND TANK OFFICIAL INSPECTION MORT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 <br />468.3420 COUNTY # <br />SITE NAME: wafed nj r o,, 5A - INSPECTION DATE: <br />SITE ADDRESS: qLj Oj5 L �,�,100 CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR 8 SUBMITTED? <br />TANK <br />COMPUTER <br />NUMBER <br />TANK Z_ <br />COMPUTER <br />NUMBER <br />TANK 3 <br />COMPUTER <br />NUMBER <br />TAN K el - <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />64 <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />TANK CONTENTS <br />MAJOR MINOR <br />POWER DISCONNECTED M43 <br />R <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />INVENTORY RECONCILIATION <br />19 20 <br />21 22 .1 <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 />31 132 <br />-------- - <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />365 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 139 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED M43 <br />OWNER/OPERATOR MONITORING 44 45 <br />PERMANENT TANK CLOSURE -n, m <br />REMOVAL OF RESIDUAL MATERIALS 46 147 <br />PIPING 48 49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK 57 ONE) FOLLOWS: <br />MAJOR MINOR NO 59 <br />VIOL. ❑ VIOL. VIOL <br />OFFICE: INSP- 8EIC ED BY:/ <br />TITLE: NE: BECK: <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv 5/88 am <br />