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AGROUND TANK OFFICIAL INSPECTION R T <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 � � F� Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: -S INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP ��` <br /> CHANGES SITE/OWNER/PERMIT? YIES WO TANK f TANK �- TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER II COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER # PER # PER# PER # PER # <br /> [ � ` EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATI NAL TANK TANK CONTENTS <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 29 130 <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 " � 5 <br /> REMOVAL OF RESIDUAL 444 .K45 :] <br /> 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 42 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 VI LATIONS AND MUST BE CORFjECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ��L i,n. <br /> 57 58 <br /> MAJORMINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP-(W RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 Whi1ti-'Jrcir l Yellow-Owner's Copy Pink-File Copy " <br />