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UNWERGROUND TANK OFFICIAL INSPECTION R1140RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.Sen Joaquin Street <br /> COUNTY NAME Jfp� Mes�°n°n e P.O.o3se� coulff Y <br /> SITE NAME: B5 P 'Boys INSPECTION DATE: <br /> SITE ADDRESS: ?4G 6_ '4F, /b� t CITY/STATE/ZIP <br /> CHANGES SITE/OWooNER/PERMIT? YES NO /TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> r D W/7 KA, ZL PER# PER# PER# PER# <br /> T EXP.DATE EXP.GATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TAN"C°NIEN15 <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 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 /> SAMPLING29 30 <br /> APPROVED TANK REPAIRS *,23%5 <br /> _._.._.. <br /> UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED Fi h4wcicc�Q. 7 eGpz ,. <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:MAJORZ <br /> 57 58 59 <br /> VIOL. ❑ VIOLL..R ❑ NO <br /> VOL.❑ <br /> OFFICE: INSP: REO, <br /> E Y: <br /> TITLE:'S J5N;40r NS PHONE: RECK: <br /> HUT-3 White-Orginal Yellow-Owner's Copy Pink-File Copy <br />