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UN*"%w3ROUND TANK OFFICIAL INSPECTION Rt—.T <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME Mailing Address: P.O.Box 388 <br /> Stockton,CA 95201-0388 <br /> ase-342. COUNTY # <br /> SITE NAME: . <br /> SITE ADDRESS: INSPECTION DATE: <br /> CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PER ? YES NO TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE TANK j TANK TANK <br /> NUMBER COMPUTER COMPUTER COMPUTER / <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER <br /> �� O PER# PER# PER# PER# <br /> EXP.DATE EXP DATE EXP DATE . <br /> OPERATIONAL TANK nwKCON1EM EXPDATE <br /> : '. <br /> MAJORINOR <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 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 - <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 <br /> INVENTORY RECONCILIATION 21 22 'I <br /> ----.—_.✓_ ____Y <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN X3132 <br /> J <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <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 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: <br /> 58 59 <br /> VIOL R 57 Q'' <br /> VIOMINL. ❑ VOL❑ <br /> OFFICE: INSP: �j_ R CEI <br /> TITLE Lee, PHONE: REC <br /> 411 IT-7 Whee-Orninal Yellow-Owner's Copy Pink-File Copy <br />