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UNORGROUND TANK OFFICIAL INSPECTION RLOAT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Bax 388 7 <br />CUUNTY NAME a dG_' OLU"AL"ass 3a2o �-� UUUr1I t rt <br />SITE NAME: INSPECTION DATE: <br />SITE ADDRESS: 7 7 _ � � � CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK �� TANK TANK TA K <br />FORM RAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br />011r ! I KAM 1=0 NUMBER' vm NUMBER NUMBER NUMBER <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTS <br />41 42 <br />43 <br />44 <br />MAJQR MINOR_ <br />1 2 <br />48 49 <br />3 4 <br />5 1Bp/ <br />7 8 <br />9 10 <br />11 102 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />135 136 <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />3B 39 <br />40 <br />41 42 <br />43 <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />INSP: ./ <br />TITLE:<' J <br />CEIVED BY: <br />&/ k, rLC�c�vt <br />PHONE <br />BECK <br />46 47 <br />48 49 <br />50 <br />51 52 <br />53 54 <br />5556 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />OLLOWS:z <br />FOLLOWS:---- <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR e57MINOR 58 NO 59 <br />VIOL. VIOL, VIOL. <br />(�7z-z <br />HUT -3 White - Original Yellow • Owner's Copy Pink - File Copv <br />INSP: ./ <br />TITLE:<' J <br />CEIVED BY: <br />&/ k, rLC�c�vt <br />PHONE <br />BECK <br />HUT -3 White - Original Yellow • Owner's Copy Pink - File Copv <br />