Laserfiche WebLink
COUNTY #,3 9 <br />INSPECTION DATES,7 <br />TANK <br />U*IRGROUND TANK OFFICIAL INSPECTION R&T <br />COMPUTER <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />NUMBER <br />PER# 6le— <br />ENVIRONMENTAL HEALTH DIVISION <br />EXP. DATE <br />445 N. San Joaquin Street <br />COUNTY NAME <br />Mailing Address: P.O. Box 388 <br />Stockton, CA 95201-0388 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />�A—468-3420 <br />SITE NAME: <br />APPROVED MONITORING SYSTEM <br />SITE ADDRESS: 71CITY/STATE/ZIP <br />53 <br />CHANGES SITE /OWNER/PERMIT? YES NO <br />TANK <br />TANK Z -- <br />FORM A AND/OR B SUBMITTED? <br />11 12 <br />COMPUTER <br />COMPUTER <br />35 36 <br />NUMBER <br />PER # � 14- <br />NUMBER <br />PER # <br />TYPE F INSPE TION <br />ISITE COMPUTER # <br />> <br />MONITORING RECORDS MAINTAINED <br />V7 — <br />16 <br />EXP. DATE <br />EXP. DATE <br />OPERA11ONAL TANK <br />TANK CONTENTS <br />SIM= <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />COUNTY #,3 9 <br />INSPECTION DATES,7 <br />TANK <br />TANK 4, <br />COMPUTER <br />COMPUTP <br />NUMBER <br />PER# 6le— <br />NUMBEPj <br />PER# /0 X— <br />EXP. DATE <br />EXP. DATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />3 4 <br />21 22 <br />TANK GAUGING <br />23 24 <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 V 8 <br />50 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />51 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />53 <br />APPROVED TANK REPAIRS <br />31 32 <br />----T <br />55 <br />MONITORING SYSTEM <br />11 12 <br />SAFETY HAZARD <br />35 36 <br />APPROVED MONITOR FREQUENCY <br />13 /,14 <br />-1-5 <br />MONITORING RECORDS MAINTAINED <br />V7 — <br />16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />INVENTORY RECONCILIATION <br />19 20 <br />21 22 <br />TANK GAUGING <br />23 24 <br />48 <br />APPROVED RESPONSE PLAN <br />25 27ii7o <br />50 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />51 <br />SAMPLING <br />29 30 <br />53 <br />APPROVED TANK REPAIRS <br />31 32 <br />----T <br />55 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />38 39 <br />40 <br />41 42 <br />M43 <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />91 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />----T <br />55 <br />5-6 <br />;YSTEM STATUS (MUST MARK ONE) <br />MAJOR 1 57 MINOR 58 NO 59 <br />VIOL. 57 MINOR <br />El VIL. 1:1 <br />OFFICE: INSP- /I <br />Hrl t_t",f <br />TITLE: <br />HUT -3 White - Orilginal Yellow - Owner's Copy Pink - File Copv <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <2. — <br />I IV viaffftw <br />RECK: <br />