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Ulses,ORGROUND TANK OFFICIAL INSPECTION RbmodRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.Sen Joaquin Street <br /> COUNTY NAME <br /> —� Mailing Address: P.O.Box See COUNTY # 3�� g� stakten�c 34201-ossa <br /> SITE NAME: at- W4— INSPECTION DATE:.3-16I <br /> SITE ADDRESS: / 1 /� O /� 1 L CITY/STATE/ZIP �s <br /> CHANGES SITE/OWNER/PERMIT? YES NO TPW TANK .3 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER # PER# PER# PER# <br /> "(-' - �' �-� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OP RATIONAL TANK > cowmsnT <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 I <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 j <br /> MONITORING RECORDS MAINTAINED /5 16 r <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN A3334 <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38t45 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED I <br /> OWNER/OPERATOR MONITORING 44 <br /> 1 <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 �' Z7k &l.-a' <br /> 57 <br /> MAJOR MINOR 58 NO 59f— Lfm <br /> A <br /> VIOL. ❑ VIOL. ❑ VIOL <br /> OFFICE: IN: _ — RECEIVED BY: <br /> TITLE: f PHONE: RECK: <br /> HUT-3 WmN-Orioinal Yellmv-Owner's Copy Pink-File Copy <br />