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UNDERGROUND TANK OFFICIAL INSPECTION R PE ORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> S> 445 N.Sen Joaquin Street <br /> a tv �oQ Mailing Address: P.O.BOX 388 <br /> COUNTY NAME ' Stockton. 34�1-0388 COUNTY # <br /> SITE NAME: Ve, t f e,r lay h i n INSPECTION DATE:3 <br /> SITE ADDRESS: / D35 S, R t,,� 4' CITY/STATE/ZIP StOC'\ yc�� <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 IN PE TI ANa SfTE COMPUTER s NUMBER NUMBER NUMBER NUMBER <br /> I A� �tmv✓� a3 i a iia PER <br /> DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK COIWWNI <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 77 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 16 <br /> PIPING 19 :R <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> 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 133 134 <br /> SAFETY HAZARD 135 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <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 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:.p 42,4?Li <br /> 57 58 59 <br /> OLO . <br /> R ❑ MINOR ❑ VOL.❑ — <br /> OFFICE: INSP: Q RECEIVED BY: <br /> TITLE:✓4-r•c�`�/����i o1` R45 PHONE: RECK: <br /> HUT-3 Wnfte-Original Yellow-Owner's COPY Pink-File COPY <br />