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U#GROUND TANK OFFICIAL INSPECTION ROT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> ilinRO.Box <br /> COUNTY NAME MaStockton,rCA 95201-0388388 <br /> 468-3420 COUNTY # <br /> SITE NAME: <br /> - ISLI` lAn 2 INSPECTION DATE: a! <br /> SITE ADDRESS: /r v !� CITY/STATE/ZIP !C/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER # <br /> EXP DATE EXP.DATE EXP DATE EXP.DATE <br /> OPERA-n NAL TANK TANK CONTEN15 <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 / <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM - ""— <br /> 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 7 1g "` <br /> PIPING ._._. _.._._... ...._.._ _._". <br /> 19 <br /> INVENTORY RECONCILIATION 21 <br /> TANK GAUGING23 24 ..—_._— — _._—._.. . ... .. <br /> APPROVED RESPONSE PLAN 25 ---'—'- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 —��-- <br /> SAMPLING __..__ <br /> 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 <br /> NDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> ........ .. <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING " <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 5U <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:MAJO 57 58 59 <br /> � B' <br /> No <br /> VIOL, ❑ VIOLL..R ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIV <br /> I <br /> C � <br /> TITLE: PHONE: RECK: <br /> HIIT-3 Whita.ndninal Yailnw.nwnore Cn,.., 01.6 cvi_..__.. <br />