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.Adb� <br />UND&OUND TANK OFFICIAL INSPECTION REP4P <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: <br />SA <br />INSPECTION DATE: Vr <br />SITE ADDRESS: U _f' 0 iZ" -0 CITY/STATE/ZIP <br />CHANGES SITE/OWN R/PERMIT? YES NO <br />FORM A AND/OR 8 SUBMITTED? <br />TANK <br />COMPUTER <br />NUMBE7 1)& 0 <br />PER # V <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # 0 L --'PER <br />EXP. DATE <br />TANK " <br />COMPUTER <br />NUMBS <br /># <br />EXP DAT E' <br />TANK <br />COMPUTER <br />NUMBE� 676PAO <br />PER # _ L4 <br />EXP. DATE <br />TYPE -OF INSPCTION <br />I -A ZI )A7�6 <br />SITE COMPUTER # <br />-�l <br />OPERATIONAL TANK <br />TANK CONTE NTSig <br />mmm <br />�yqgi, <br />,gg <br />MAJOR MINOR <br />1 2 <br />46 47 <br />48 49 <br />PERMIT TO OPERATE <br />53 54 <br />CHANGE IN CONDITIONS TO OPERATE <br />:55a 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: 1&61401t�� -7717D Ae-1L*'*%1-t <br />7 <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <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 />19 20 <br />------------- - <br />INVENTORY RECONCILIATION <br />2 22X <br />TANK GAUGING <br />—1 <br />23 24 <br />11-1-1-1 --- 11-----,------------- <br />----- ---- ---- <br />APPROVED RESPONSE PLAN <br />25 26 <br />--- ------------ <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 />135 136 <br />1 <br />CONDITIONS ABATED <br />VA 37 <br />1 NDq PLO , <br />1*11v = <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 />'YSTEM STATUS (MUST MARK ONE) <br />�-Im <br />1V <br />�m <br />ffi� 43 <br />TITLE: <br />�-XP <br />44 145 <br />Yellow - Owner's Copy <br />Pink - File Copv <br />L I _ _ <br />46 47 <br />48 49 <br />50 <br />51 52 6-S <br />53 54 <br />:55a 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: 1&61401t�� -7717D Ae-1L*'*%1-t <br />7 <br />57 58 59 <br />MAJR MINOR NO <br />VIOL.O91 VIOL. El VOL. H <br />OFFICE <br />EEO <br />- <br />�&- 4 -,u <br />TITLE: <br />�-XP <br />HUT-3 White - Original <br />Yellow - Owner's Copy <br />Pink - File Copv <br />I WA <br />5/88 0 m <br />