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*ERGROUN"D TANK OFFICIAL INSPECTIONORT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San JoaquinStreet <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 COUNTY # <br />488.3420 <br />SITE NAME: ''�� <br />TANK CO <br />INSPECTION DATE: <br />SITE ADDRESS: <br />55 To v lam„® <br />"� - <br />CITY/STATE/ZIP <br />1 <br />/TANK <br />CHANGES SITE/OWNER/PERMIT? ' YES <br />NO TANK ® <br />TANK <br />TANK <br />APPROVED CONSTRUCTION <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />�v <br />COMPUTER <br />COMPUTER <br />7 <br />COMPUTER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />NUMBER <br />NUMBER <br />NUMBER <br />MONITORING SYSTEM <br />NUMBER <br />j� <br />,7 <br />PER # <br />PER # <br />PER # <br />PER # <br />,`oC,-72^ <br />16 t/ <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />18 <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CO <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 />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />16 t/ <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 />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 />36 <br />CONDITIONS ABATED <br />//. <br />37 <br />TEMPORARY TANK CLOSURE <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 />SYSTEM STATUS (MUST MARK ONE) <br />57 59 <br />MAJOR MING��,[[58 NO <br />VIOL. ❑ VIOL. t�.L VIOL. ❑ <br />46 <br />48 <br />50 <br />51 <br />53 <br />55 <br />OFFICE: INSP: �`oiG RECEIVED BY: <br />TITLE: /�'� ry `� i PHONE; / i BECK: <br />l 1y�-o33-7 <br />