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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 /> COUNTY NAME Mailing Address: P.O.Box 388 <br /> Stockton,CA 95201.0388 <br /> 468-3420 COUNTY # <br /> SITE NAME <br /> INSPECTION DATE: <br /> SITE ADDRESS: <br /> CITY/STATE/ZiP <br /> CHANGES SITE/OWNER/PERMIT? Y <br /> FORM AAND/QR B SUBMITTED? NO TANK TANK Z- TANK <br /> COMPUTER ' COMPUrER TANK <br /> TYPE F INSPECTION SITE COMPUTER# NUMBER COMPUTE COMPI <br /> NUMBER NUMBER �C� <br /> I y PER # PER # <br /> EXP DATE PER PER <br /> # PER # <br /> OPERATIONAL TANK TANK CONTENTS - EXP- EXP.DATE <br /> DATE EXP.DATE <br /> PERMIT TO OPERATE MAJOR MINOR <br /> CHANGE IN CONDITIONS TO OPERATE 1 2 <br /> 3 4 <br /> APPROVED CONSTRUCTION <br /> 5 6 <br /> WRITTEN MONITORING PROCEDURES <br /> APPROVED MONITORING SYSTEM 7 8 <br /> MONITORING SYSTEM 9 1 <br /> APPROVED MONITOR FREQUENCY 11 122 <br /> 13 14 <br /> MONITORING RECORDS MAINTAINED <br /> 15 16 <br /> ACCESS CASING SECURED <br /> 17 18 <br /> PIPING <br /> INVENTORY RECONCILIATION 19 2 <br /> TANK GAUGING 21 222 <br /> APPROVED RESPONSE PLAN 23 24 <br /> 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 <br /> SAFETY HAZARD 34 <br /> 35 36 <br /> CONDITIONS ABATED <br /> 37 <br /> TEMPORARY TANK CLOSURE g` <br /> REMOVAL OF RESIDUAL 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED <br /> 43 <br /> OWNER/OPE ING 45 <br /> PERMANENT TANK CLOSURE r <br /> REMOVAL 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 5Q <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> SYSTEM STATUS(MUST MARK ONE) TH KED ITEMS REPRESENT VIOLATIONS AND MUST BE CORIJECTED AS <br /> 57 F LOWS: <br /> MAJOR MINOR I� NO 59 — ----- — — <br /> VIOL. LJ VIOL. I_I VIOL -- —– --- --- <br /> �- <br /> RECEIVED BY: <br /> TITLE: PRONE. <br /> BECK: <br /> HLT-3 1,vtij s-Or',cir.sl Yellow-Owner's Copy Pink nF-File Gnpy <br />