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U. _RGROUND TANK OFFICIAL INSPECTION Rftmi <br /> SAN JOAGWN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 4A5 N.Son Joaquin SVset <br /> Mailing Address: P.O.Boa 388 <br /> COUNTY NAME g Q� -s ,xw\, <br /> Stockton.C 34 1-0388 / COUNTY # <br /> 468 <br /> SITE NAME: S f o�to�. Loclr <0A ouk�d INSPECTION DATE:�z <br /> SITE ADDRESS: 2a-T1 E. E, CRY/STATE/ZIP Lod" CA QSz4I, <br /> CHANGES SITE/OWNER/PERMIT. YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# ISS'Y-o2 PER# PER# <br /> _ 1558-o I <br /> Cl � � EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK °1N1CON'Em <br /> MAJOR MINOR o <br /> PERMIT TO OPERATE 1 2 _— <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _ <br /> APPROVED CONSTRUCTION 5 6 L2. <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 <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 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36 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 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> nUNAUTHORIZED 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 /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: ^ 1_ \ RECEIVED BY: <br /> TITLE: ` ,v\ 71 1 Ccs` PHONE: BECK: <br /> HUT-3 Wase original Yellow-Owners Copy Pink-File Copy 5ies ©M <br />