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UN,,,fRGROUND TANK OFFICIAL INSPECTION R1kr4RT <br /> be, SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.Sen Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # ' <br /> ` 468-3420 <br /> SITE NAME: . INSPECTION DATE. <br /> SITE ADDRESS: ( � )� `: f i/J/( ` �l , CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER,c NUMBER NUMBER NUMBER NUMBER <br /> rw; <br /> , PER # PER a PER r I PER x <br /> EXP_DATE EXP.DATE EXP.DATE I EXP DATE <br /> :. .. '.' <br /> OPERATIONAL TANK TANK CONTENn <br /> ►. MAJOR I MIN <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 /> r APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 I <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 _ <br /> rUNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 — -- <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 - -- <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL N14 <br /> 39FLAMMABLE VAPORS REMOVEDACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED VI <br /> 3 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> V REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MAST RF CCIRRFCTED AS <br /> � SYSTEM STATUS(MUST MARK ONEI FO OWS: ? D�' •rf _ _ <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ VIOL. ❑ VIOL❑ <br /> r <br /> OFFICE: INSP:�'— , RECEIVED BY: <br /> r J�. <br /> r - <br /> r <br /> SEN O(� Ur...� r Vic, <br /> TITLE: t 1 t H,, PHONE: RECK <br /> HUT-3 White Original Yellow Owner's Copy Pink-File Copy „ r <br />