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U*dEERGROUND TANK OFFICIAL INSPECTION RtIlORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ('' 445 N.San Joaquin Street <br /> COUNTY NAME,\�f.�_ 1 J oa Mailing todress: P.O.Box388 <br /> 8 <br /> ��YV �J ling Mon,CA 95201-0386 <br /> / 466-3420 COUNTY #,5 <br /> SITE NAME: (�_- J O`, /4," J ! <br /> iN-G CST ,Y/ INSPECTION DATE: �G_� Q <br /> SITE ADDRESS: / 3 �n CITY/STATE/ZIP Sf p <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER TANK 3 TANK <br /> COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> Y' ? PER# PER# PER# PER# <br /> J EXP.DATE EXP.DATE EXP.DATE EXP. <br /> OPERATIONAL TANK '""' °O DATE <br /> [� a 7, 4e z t. <br /> MAJOR MINOR <br /> PERMIT TO OPERATE <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 16 <br /> PIPING 79 20 <br /> INVENTORY RECONCILIATION 21 22 - <br /> TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 -- - <br /> SAMPLING 29 <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 v <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 69 <br /> MAJOR <br /> ONO L. ElVIOLO.R LJVIOL.F-1 <br /> OFFICE: INSP: r RECEIVED Y: <br /> rj [� 1/ <br /> TITLE: 'Sle/0 n/I� RL/70 NKRECK: <br /> a IO <br /> HUT-3 While-Original Yellow-Owners Copy Pink-File Coov .:,�_ <br />