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U1��RGROUND TANK OFFICIAL INSPECTION Rti/RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street q <br /> COUNTY NAME <br /> Mailing c on5.0.-038388 COUNTY # l <br /> Stocktton,,CA CA 95201-0388 <br /> 488-3420 /� <br /> SITE NAME: TN Idle, D 1 / _ INSPECTION DATE: <br /> SITE ADDRESS: 1\R. /5/M� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TAIK TANKTANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ,�) COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBE10 V NUMBER NUMBER NUMBER <br /> PER# E�t q PER# PER# PER# <br /> EXP.DAT EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TMKGON1ENT5 <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 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 r <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIO S AND MUST BE GORR T S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO .59 I ^ <br /> VIOL. ❑ VIOL. ❑ VIOL.IQ" <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE:S� PHONE: RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy siva OO M <br />