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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 />iYSTEM STATUS (MUST MARK ONE) <br />�12 <br />46 47 <br />48 49 <br />50 99 <br />51 52 <br />53 54 <br />55 56 <br />MAJOR 57 MINOR 58 59 <br />NO jjQj <br />VIOL. LJ L. ❑ VIOL. LIN <br />OFFICE <br />I <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />TITLE wee <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copy <br />RECEIVED BY: <br />LC <br />PHON / <br />BECK: <br />5/88 (D M <br />IDERGROUND TANK OFFICIAL INSPECTIEPORT <br />SAN JOAQUIN PUBLIC HEALTH SERVIC <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME <br />Stockton, CA 95201-0388 <br />COUNTY # <br />468.3420 <br />SITE NAME: f _ <br />INSPECTION DATE: <br />SITE ADDRESS: f <br />%� )d <br />>/ h j 9-7— CITY/STATE/ZIP <br />CC+ 9� 76 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO TANK% TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTE;:5 COMPUTER <br />NUMBE� NUMBED <br />UMBER BER <br />TYPE OF INSTION SITE COMPUTER # <br />PE <br />2�' 3 <br />PER # QQ PER # NS <br />PER # P PER # <br />/ <br />ol <br />EXP. DATFJ` EXP. DATE <br />EXP. DATE XP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR ..� <br />PERMIT TO OPERATE 1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING <br />29 <br />30 <br />0 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />134 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />/ <br />37 <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 />iYSTEM STATUS (MUST MARK ONE) <br />�12 <br />46 47 <br />48 49 <br />50 99 <br />51 52 <br />53 54 <br />55 56 <br />MAJOR 57 MINOR 58 59 <br />NO jjQj <br />VIOL. LJ L. ❑ VIOL. LIN <br />OFFICE <br />I <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />TITLE wee <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copy <br />RECEIVED BY: <br />LC <br />PHON / <br />BECK: <br />5/88 (D M <br />