Laserfiche WebLink
UORGROUND TANK OFFICIAL INSPECTION ART <br />SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME 5` Stockton4, CA 95201-0388 COUNTY# <br />68-3420 <br />SITE NAME: INSPECTION DATE: <br />SITE ADDRESS: <br />" ml C1E L <br />E. 0-1-UlA(—L1�CITY/STATE/ZIP,` (,./A <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK <br />TANK <br />TANK 3 <br />TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />OW cto—,� 21 PER # <br />3 <br />PER # <br />PER # <br />PER # <br />r� EXP DATE <br />EXP DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TAN <br />TANK CONTENTS <br />-- ----- ---- <br />"mm <br />MAJOR MiNOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 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 />APPROVED RESPONSE PLAN <br />25 26 <br />... .......... .... <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <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 />7/, 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 />38 39 <br />40 91 <br />41 42 <br />M43 <br />44 45 <br />46 47 <br />48 49 <br />50 m <br />51 52 <br />53 54 <br />55 <br />56 <br />(STEM STATUS (MUST MARK ONE) <br />57 58 <br />MAJOR MINOR <br />VIOL. 11 VIOL. 1:1 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />Fni i nw-,-- e -C— 17) qC,,a- <Q <br />59 <br />NO <br />VIOL. El <br />INSP: a <br />RECEIVED By;� <br />TITLE: �r-/V�O/Q- PHONE: <br />U <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv 5/88 0 M <br />