REMOVAL_1994 - Laserfiche WebLink

Home Browse Search

UNbEfiGROUND TANK OFFICIAL INSPECTION REPWOT SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N.San Joaquin Street Mailing Address: P.O.Box 388 COUNTY NAME Stmkton,CA 95201.0388— 468-3420 COUNT/ # 9 SITE NAME: INSPECTION DATE:lo# SITE ADDRESS: / n /_ CITY/STATE/ZIP S CHANGES SITE/OWNER/PERMIT? YES NO TANK ANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTEROMPUTM COMPUT COMPUTER TV OF INSPEC ON SITE COMPUTER# NUMBER (:7:� UMBEF t?X) NUMBER �, NUMBER PER# ER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK coN1FK,s MAJOR MINOR I t$'7 PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 IT— APPROVED APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 — APPROVED MONITORING SYSTEM B 1p MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 16 --- PIPING 19 -:RT— INVENTORY R INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 - SAMPLING 2g 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 1 '---" CONDITIONS ABATED IM 37 - - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 36 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 -- OWNER/OPERATOR MONITORING 44 45 ERMANENT TANK CLOSURE REMOVAL BUAL MATERIALS 46 47 PIPING 46 49 FLAMMABLE VAPORS REMOVED 50 5mm 2 ✓/// UNAUTHORIZED RELEASE 51 52 SAMPLING 53 y1 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR MINOR NO 58 59 VIOL VIOL. VIOL. OFFICE: IN CEIVED BY: 31,4y TITLE: PHONE: BECK: HUT-3 White-Original Yellow-Owners Copy Pink-File Copy 5/ea OO M