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CHANGE IN CONDITIONS TO OPERATE <br />U GROUND TANK OFFICIAL INSPECTION R T <br />3 4 <br />PIPING <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />TANK GAUGING <br />23 24 <br />APPROVED CONSTRUCTION <br />ENVIRONMENTAL HEALTH DIVISION <br />5 <br />6 <br />51 <br />445 N. San Joaquin Street <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />WRITTEN MONITORING PROCEDURES <br />Mailing Address: P.O.388 <br />7 <br />8 <br />COUNTY NAME <br />Stockton, CA 95201-0303 88 <br />APPROVED TANK REPAIRS <br />COUNTY # <br />APPROVED MONITORING SYSTEM <br />468-3420 <br />9 <br />10 <br />SITE NAME: <br />/S S <br />SAFETY HAZARD <br />INSPECTION DATE: <br />SITE ADDRESS: <br />(�, f' ,l CITY/STATE/ZIP <br />�,�.. <br />CHANGES SITE/OWNER/PERMIT? ` YES NO <br />TANK , <br />TANK <br />Z <br />TANK J2 <br />TANK cj <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />-y <br />S/ <br />PER # <br />PER # <br />PER # <br />PER # <br />E7 Cit✓'G� <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />i <br />1 x sem s <br />MAJOR MINOR.- <br />1 2 <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />3 4 <br />PIPING <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED CONSTRUCTION <br />50 <br />5 <br />6 <br />51 <br />SAMPLING <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED TANK REPAIRS <br />31 32 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />SAFETY HAZARD <br />35 36 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />.......... <br />PIPING <br />21 22 <br />TANK GAUGING <br />23 24 <br />43 <br />44 45 <br />50 <br />APPROVED RESPONSE PLAN <br />25 26 <br />51 <br />SAMPLING <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />IMPROPER ABANDONMENT <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34�� <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />/ 37 <br />10 IT410r9pfMj�r z•IOI; c <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />V1101'.91V <br />38 39 <br />46 <br />PIPING <br />40 <br />41 42 <br />43 <br />44 45 <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />PIPING <br />48 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />SAMPLING <br />53 <br />IMPROPER ABANDONMENT <br />55 <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. ❑ VIOL. <br />ITHE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: " <br />OFFICE: INSP: <br />TITLE: }�l� <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copy / <br />BECK: <br />5/88 0 M <br />