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UR►eRGROUND TANK OFFICIAL INSPECTION Rev-dhT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> COUNTY NAME 445 N.Sen Joaquin Street <br /> a'K �� Mailing Address: P.O.Box 388 <br /> J( k Stockton,CA 95201-0386 <br /> 488-3420 Cape <br /> SITE NAME: COUNTY <br /> SITE ADDRESS: Z / INSPECTION DATE: <br /> ., <br /> /'0 -Q `✓• CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK <br /> FORM A AND/OR B SUBMITTED? TANK TANK <br /> �� COMPUTER � COMPUTER 3 TANK <br /> 7YP OF INSPEC ION SITE COMPUTER# NUMBER NUMBER/ ,..IT M1CjUOMBERER COMPUTER <br /> PER# / � PER# / !/�'-' NUMBER <br /> PER # <br /> EXP.DATEPER# <br /> OPERATIONAL TANK EXP.onrE EXP onrE EXP DATE <br /> TANK CONTENTS <br /> NO /{,jj¢.( <br /> PERMIT TO OPERATE MAJOR MIR <br /> 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 g -- - " --" - - <br /> APPROVED MONITORING SYSTEM 9 10 - - -" <br /> MONITORING SYSTEM --- -- <br /> 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 - "- <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18--- - <br /> PIPING 19 <br /> INVENTORY RECONCILIATION 21 22 - -- <br /> TANK GAUGING ------------___ ___ . -. <br /> 23 24 <br /> APPROVED RESPONSE PLAN 25 28 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED ML 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITO <br /> RMANENT TANK CLOSUR <br /> REMOV MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPUNG 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: <br /> 57 58 <br /> 22. ?M• ,$ <br /> MAJOR MINOR NO 59 <br /> VIOL. VIOL. VIOL <br /> OFFICE: INSP:, RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HI IT-3 W61ts-Oncinsi Yellow-Owners Coov Pink-File Coov <br />