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• y <br /> UN%KRGROUND TANK OFFICIAL INSPECTION RL, RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> inAdess: P.O.aox <br /> COUNTY NAME M StocktonrCA 95201-0388388 201038888 <br /> 468.3420 COUNTY # <br /> SITE NAME: A; ✓Jh <br /> � C/i can av f �� �•//�,./©i� INSPECTION DATE: -/L2—F/ <br /> SITE ADDRESS: Z4O� Kiri 574 41,;t- CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 03 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> o EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK <br /> TANK CONTENTS <br /> MAJOR MINOR <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 19 120 / <br /> INVENTORY RECONCILIATION 21 22 ✓ <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 I/f <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 <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 447777777777 7771117: <br /> 45 <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 54 <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR MINOR �8 NO <br /> 57 <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INS RIVE BY: <br /> TITLE: NE: RECK <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv 5rss n M <br />