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UN GROUND TANK OFFICIAL INSPECTION RE T <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 COUNTY OUNTY # <br /> SITE NAME: t4 iodlf ILAAA-b ag, HA I,.) INSPECTION DATE: 141 <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK + TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBE-PIA NUMBER NUMBER NUMBER <br /> PER# 4 PER# PER# PER# <br /> EXP.DA EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKconrrEwrs �� � � <br /> MAJOR MINOR <br /> r <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 /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING l29 130 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> _.., <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> r <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 /> PERMANENT TANK CLOSURE � G 3 f <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 VOLATIONS AND MU T BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLO S: <br /> 5758 59 ----- -- - <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP:UAJ V_ RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy sia (T M <br />