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U^OUND TANK OFFICIAL INSPECTION R& SAN JOAQUIN PUBLIC HEALTH SERVICES j ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street Mailing Address: P.O.Boz 388 COUNTY NAME Stockton,CA 95201-0388 COUNTY # 468-3420 SITE NAME: i D INSPECTION DATE: SITE ADDRESS: t CITY/STATE/ZIP CHANGES SITE/OW ER/PERMIT? YES NO -1ANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER PER # PER # PER# PER # EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIO AL TANK TMK CONTENT . MAJOR MINOR w+ PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 _..._ APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION TI 22 TANK GAUGING J336 ..-_._.__ ..___.._......__...._. .._..�_..._L_.__......._. APPROVED RESPONSE PLAN 2611 _.� ._._ . . ....j UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS — _ �_... . I .: UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED _ .. .. , I TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 - FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 . . _ IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 57 58 59 VIOL.R ❑ VIOL. ❑ VNO IOL.❑ — OFFICE: INSP: 14 RECE D B . TITLE: C I I G PH BECK: