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UN RGROUND TANK OFFICIAL INSPECTION ART <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 COUNTY # <br />aFa-sa9n <br />SITE NAME: W& <br />,�t <br />INSPECTION DATE: 5' �Y <br />SITE ADDRESS: / <br />J <br />CITY/STATE/ZIP S�^D Q- ?6 <br />CHANGES SITE/OWNER//PERMIT??/ YES <br />NO <br />TANK f <br />TANK .Z, <br />TANKTANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTA <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER <br />re r n `J /I�6yV <br />�3 <br />' <br />I/ I <br />v <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />s <br />MAJOR MINOR <br />E 1 <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 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 />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />INVENTORY RECONCILIATION <br />19 <br />21 <br />20 <br />22 <br />�.... <br />TANK GAUGING <br />23 <br />24 <br />., ...... r- ... <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 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 />37 <br />TEMPORARY TANK CLOSURE <br />" <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 <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />Wr 77 <br />qp � <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 (MUST MARK ONE) <br />FOLLOWS: <br />57 <br />MAJOR MINOR 58 <br />NO 59 <br />VIOL. VIOL. ❑ <br />VIOL. ❑ <br />OFFICE: <br />INSP: <br />`Jr <br />RECEIV : <br />TITLE: S6/V <br />rbP— <br />PHONE: <br />RE <br />HUT -3 White -Original Yellow - Owner's Copy Pink - File Copy 5/88 0 M <br />