Laserfiche WebLink
AGROUND TANK OFFICIAL INSPECTION RWT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME Mailing Address: P.O.Box 388 <br /> Stockton.CA 68 3420 1.0388 COUNTY # <br /> SITE NAME: GoUN y /4AZ<ET <br /> INSPECTION DATE: � /[J (j <br /> SITE ADDRESS: 1Q(��� w- 4-/AINE -Roga CITY/STATE/ZIP 1 l <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK I <br /> FORM A AND/ORB SUBMITTED? TANK <br /> COMPUTER TANK <br /> COMPUTER TANK <br /> TYPE OF INSPECTION NUMBER NUMBER COMPUTER COMPUTER <br /> SITE COMPUTER# NUMBER NUMBER <br /> O l.lihc— PER# PER # PER# <br /> TJ EXP.DATEPER # <br /> OPERATIONAL TANK TANK MexP oarE ExP DATE ExP DATE <br /> PERMIT 70 OPERATE MAJOROR MI CONTENTS <br /> 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 I <br /> WRITTEN MONITORING PROCEDURES 7 8 ` <br /> APPROVED MONITORING SYSTEM Q�''� <br /> B 10 ( <br /> MONITORING SYSTEM 11 12Q.�\ <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 - . r✓I / 1 p I,( <br /> TANK GAUGING f l-1, K ct <br /> APPROVED RESPONSE PLAN 23 24 <br /> 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 - ✓` G <br /> APPROVED TANK REPAIRS 30 <br /> 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 ��ll <br /> SAFETY HAZARD35 <br /> CONDITIONS ABATED 37 <br /> 36 <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 /> SYSTEM STATUS(MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS: <br /> MAJOR 57 <br /> 58 59 <br /> VIOL. ❑ VINO <br /> O�R ❑ OL❑ <br /> OFFICE: INSSP: RECEIVED BY- <br /> d, <br /> � <br /> TI <br /> H C PHO <br /> HUT-3 White-Original Y6110W-OWn8r'S Copy Pink-File Copy <br />