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ARGROUND TANK OFFICIAL INSPECTION ART <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 <br />SITE NAME: <br />�NSPECTION DATE: <br />SITE ADDRESS:CITY/STATE/ZIP <br />CJLJ <br />CHANGES SITE/OWNER/PERMIT? YES N(Y <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTIA! <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBERj-f0 <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />NUMBER <br />PER # <br />EXP. DATE <br />TYION <br />SITE COMPUTER # <br />OPERATIONAL TANK <br />TANK CONTENTS <br />21,ys <br />m- 12 <br />------------- ____ <br />MAJOR I MINOR <br />1 2 <br />43 <br />44 45 <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 of6 <br />WRITTEN MONITORING PROCEDURES <br />7 y7o 8 <br />APPROVED MONITORING SYSTEM <br />9 ._"10 <br />MONITORING SYSTEM <br />11 v1*1 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 />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25V 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 34 <br />SAFETY HAZARD <br />35 <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 47 <br />48 49 <br />50 E9 <br />51 52 <br />53 54 <br />55 56 <br />384 39 <br />40 m <br />41 42 <br />43 <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 47 <br />48 49 <br />50 E9 <br />51 52 <br />53 54 <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />58 59 NO <br />MINOR <br />VIOL. e VIOL. ❑ VIOL. H <br />OFFICE-, INSP: <br />TITLE / -�5 1,707 <br />Sr t PHONE- BECK: <br />I I f <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />5/88 0 m <br />