Laserfiche WebLink
UORGROUND TANK OFFICIAL INSPECTION R&T <br />• SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME b Stockton, CA 95201-0388 COUNTY # <br />468-3420 <br />SITE NAME: <br />= t3� <br />INSPECTION DATE: <br />SITE ADDRESS: I l-!�3 1. .COLA) <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK j <br />TANK 2 <br />TANK 3 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER i...� (�-+ <br />NUMBER <br />PER # <br />NUMBER <br />PER # UL P <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />Qlf:'�t, yL <br />�'[ <br />EXP. D E <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTenTs <br />MAJOR MINOR <br />.. .. .':._ .3i.? r!, .• <br />, <br />PERMIT 10 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 />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />112 <br />MONITORING SYSTEM <br />11 <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 />✓ ✓" <br />�, <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIIJS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />136 <br />V <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />m 43 <br />OWNER/OPERATOR MONITORING <br />44 <br />i45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />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 />155 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUSE MURK ONE) <br />— <br />FOLLOWS:57 <br />--- ------ <br />58 <br />59 <br />---- <br />-- - --- <br />MAJOR <br />[jVIOLO.R ❑ NO <br />❑ <br />VIOLVOL. <br />_ <br />— <br />OFFICE: <br />INSPv <br />F-2CZy <br />RECEIVEDB : <br />T045H 10 KA <br />! <br />TITLE: <br />PHONE: BECK! <br />HUT -3 While - Original Yellow - Owner's Copy Pink - File Copy <br />PHS 178 (4/96) <br />