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Uhw,eRGROUND TANK OFFICIAL INSPECTION R6..JRT <br />SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mallin, Address: P.O. Box 388 <br />COUNTY NAME Slockton,CA95201-0388 COUNTY UUNiI # <br />SITE NAME: <br />14 INSPECTION DATE: <br />SITE ADDRESS: /L?z <br />In_j ITY/STATE/ZIP <br />CHANGES SITE/OWN /PERMI 9 <br />YESdNOTAN <br />TANK <br />TANK <br />TANKFORM <br />A AND/OR B SUBMITTED? <br />COMPLI <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYP F INSPECTION <br />SITE COMP R #NUM <br />PER # <br />PER # <br />PER # <br />ERPER <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP.DATE <br />OPERATIONAL TANK <br />MAJOR MINOR <br />P <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 />2g <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 />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />IqA <br />139 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W44457 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED IX REPRES T VIOLATIONS D MUST BE COR TED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />c <br />57 58 <br />9 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL VIOL. VIOL. <br />OFFICE: <br />INSP: . <br />RECEIVED BY: <br />PHONE: <br />1 <br />BECK: <br />TITLE:5f, 64 <br />HUT -3 White - Original Yellow - Owner's Capt Pink - File Copy 5/89 OM <br />