Laserfiche WebLink
AGROUND TANK OFFICIAL INSPECTION RIORT <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 da4A, Stockton, CA 95201-0388 <br />468-3420 COUNTY # <br />SITE NAME: / <br />INSPECTION DATE:3-36--i <br />LA4 <br />SITE ADDRESS: <br />CITY/STATE/ZIPS-(5Ce <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK <br />1 <br />TANK <br />CHANGE IN CONDITIONS TO OPERATE <br />TANK <br />'TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />6 <br />COMPUTER <br />7 <br />COMPUTYR <br />COMPUTER <br />9 <br />10 <br />NUMBER <br />11 <br />NUMBER <br />APPROVED MONITOR FREQUENCY <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITECOMPUTER # <br />16 <br />tt <br />PER # <br />18 <br />PER # <br />19 <br />PER # <br />PER # <br />21 <br />22 <br />EXP. DATE <br />23 <br />EXP. DATE <br />APPROVED RESPONSE PLAN <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <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 />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 />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 />W, <br />37 <br />TEMPORARY TANK CLOSURE <br />46 47 <br />48 49 <br />50 <br />51 52 <br />53 54 <br />REMOVAL OF RESIDUAL 38 39 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS:s4t, n &a <br />FLAMMABLE VAPORS REMOVED 40 m <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED m 43 <br />OWNER/OPERATOR MONITORING 44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 47 <br />48 49 <br />50 <br />51 52 <br />53 54 <br />155 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS:s4t, n &a <br />SYSTEM STATUS (MUST MARK ONE) <br />57 MINOR r -i 58 NO 59 <br />MAJOR <br />VIOL. VIOL. ❑ VIOL. <br />OFFICE: INSP-V-"RECEIVE,15 BY: <br />T <br />TITLE: , PHONE.—� <br />1SW <br />HUT-3 White - Original Yellow - Owner's Copy Pink - File Copy 5/88 0 m <br />