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If E TI AL TANK <br />TANK coNrENrs <br />MAJOR MINOR <br />U <br />GROUND TANK OFFICIAL INSPECTION ROT <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />4 <br />APPROVED CONSTRUCTION <br />ENVIRONMENTAL HEALTH DIVISION <br />6 <br />WRITTEN MONITORING PROCEDURES <br />445 N. San Joaquin Street <br />Address: P.O. Box 388 <br />COUNMailing <br />TY E <br />APPROVED MONITORING SYSTEM <br />Stockton, CA 95201-0388 <br />10 <br />MONITORING SYSTEM <br />468-3420 <br />SITE NAME: <br />.("dr <br />APPROVED MONITOR FREQUENCY <br />'�7 <br />r <br />SITE ADDRESS: <br />MONITORING RECORDS MAINTAINED <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />19 <br />20 <br />COMPUTER COMPUTER <br />21V7'22 <br />TANK GAUGING <br />NUMBER NUMBERPER <br />TYPE OF INSPECTION <br />ISITE COMPUTER # <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />z/ <br />28 <br /># PER # <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />EXP. DATE EXP. DATE <br />If E TI AL TANK <br />TANK coNrENrs <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />SAMPLING <br />o,8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 • <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />4 <br />MONITORING RECORDS MAINTAINED <br />15 17 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21V7'22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />3fi <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />38 39 <br />40 <br />46 47 <br />PIPING <br />41 42 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />44 45 <br />52 <br />SAMPLING <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 />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />SYSTEMSTATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 59 <br />NO <br />VIOL. VIOL. ❑ VIOL. ❑ <br />• �� <br />HUT -3 WNte - Original Yellow - Owner's Copy Pink - File Cony <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />o <br />— — IRECK <br />