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AWFIGROUND TANK OFFICIAL INSPECTION REIdRT <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEAL THPIVISION <br /> 304 E.Weber Ave., bird loo( <br /> Meiling Address:P.O.Box 388 <br /> COUNTY NAME Slppklon,CA95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: 57�^1���-- / INSPECTION DATE: /o/S <br /> SITE ADDRESS: ZfZs h/� /N CITY/STATE/ZIP �eA� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK or TANK of 7-- TANK 2jF TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER PER PER 9 PER PER+7 <br /> ✓ �// EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> tl1NK COMENIS rip < y - roe�j 1 I, X12;1} - <br /> OPERATIONAL TANK k <br /> - <br /> PERMIT TO OPERATE I 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 i l 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 :i ... - - <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 T "` <br /> REMOVAL OF RESIDUAL W44t45 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> ,y y i <br /> ANK_CE <br /> .�RMANENT T E ;._ x Mail'w . _r m i <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT V�II%AATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 4a5 eiwy f44 — -- <br /> 57 58 59 <br /> MINORE] NO <br /> Lj VIOL. VIOL. <br /> OFFICE: INSP: rL RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 While-Odpinal Yellow-0.0"s Copy Pink-Fee Copv PHS 178 (4196) <br />