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U4GROUND TANK OFFICIAL INSPECTION AT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,68 342001-0388 COUNTY # <br /> SITE NAME: <br /> t I - INSPECTION DATE: <br /> SITE ADDRESS: fa CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? ES NO TANK TANK TANK a�TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 23 ES PER# PER# PER# PER# <br /> EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCONIENTS a,• <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 g 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 p <br /> INVENTORY RECONCILIATION 21 22 <br /> TANKGAUGING23 24 <br /> APPROVED RESPONSE PLAN 25 26 -' --�/ <br /> UNAUTHORIZED RELEASE OCCURRENCE 2728 �- -- <br /> SAMPLING <br /> 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> AUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD 35 36 <br /> DITIONS 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 * v <br /> Y �1... <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: S-4 , <br /> 57 58 59 <br /> MAJOR MINOR <br /> MINOVIOL.R NO <br /> VIOL. ❑ VIOL.❑ — <br /> OFFICE: INSP: RECEIVED BY: <br /> Lvel, l4 azf,5-r6 <br /> TITLE:I, ee—N S PHONE: RECK: <br /> HUT-3 Wnite-original Yellow-Owner's Copy Pink-File Co v - <br />