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UNI,�GROUND TANK OFFICIAL INSPECTION RE1a*44T <br /> 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 OUNTY # <br /> SITE NAME: / / ��C / INSPECTION DATE: <br /> SITE ADDRESS: ��✓ ,4177- j,/;0VeITY/STATE/ZIP 45A, ,r37tl <br /> RANGES SITE/OWNER/PERMIT? YES NO TANK / TANK /Z TANK 2> TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER n COMPUTER COMPUT5 �1 ,` COMP T <br /> NUMBER/a NUMBER/,q O&) NUMBEF b VOv NUM <br /> TYPE OF INSPECTION SITE COMPUTER <br /> PER# �. )r O PER# PER # ��^"/Q PER# <br /> Ld EXP_DATE vv EXP.DATE EXP.DATE V EXP.DAT <br /> OPERATIONAL TANKTANK CON NT <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 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) S�f <br /> FOLLOWS: �� <br /> 57 58 59 <br /> MAJOR MINORNO611 j" <br /> VIOL LJVIOL. ❑ VIOL. <br /> OFFICE: INSP: / _ / RECEIVED BY: <br /> TITLE:SW� PHONE: BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv 5iee OM <br />