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UN%%vAGROUND TANK OFFICIAL INSPECTION RLindRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address. P.O.Box 388 ^ <br /> COUNTY NAME Stockton,CA 95201-0388 CS <br /> 468-3420 COUNTY # <br /> SITE NAME: 1 l INSPECTION DATE: <br /> ill <br /> SITE ADDRESS: 1 ITY/STAT <br /> fr <br /> CA-is' <br /> r <br /> CHANGES SITE YES NO TANK TANK TAN TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER CO PUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBERjo00 ryrZ NUMBER NUMBER NUMBER <br /> Vn v,� �"� PER# L /Y� PER# PER# PER# <br /> 1 CI (J EXP.DATE JD XP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTEN S <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 /> 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 U43 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 5 <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: iAP—,m <br /> MAJOR 57 MINOR 58 NO 59 h{ <br /> VIOL. ❑ VIOL. ❑ VIOL <br /> OFFICE: INSP. RECEIVED BY: <br /> 0 TITLE:(/J / LJ. PHONE RECK <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />