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AGROUND TANK OFFICIAL INSPECTION R&T SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION COUNTY NAME 445 N.San Joaquin Street Mailing Address: P.O.Box 388 Stockton,CA 95201 0388 SITE NAME:. 4683420 COUNTY # =0S INSPECTION DATE: I' / SITE ADDRESS. T71 CHANGES SITE/OWNER/PERMIT? YES NOK CITY/STATE/ZIP FORM A AND/OR B SUBMITTED? TANK TANK TANK TYPE OF INSPECTION NUMBER �R# COMPUTER COMPUTER COMPUTER SITE COMPUTER# NUMBER NUMBER COMPUTER PER# PER# PER# NUMBER PER # EXP DATE EXP DATE OPERATIONAL TANK TANK CONTENTS EXP DATE EXP.DATE MAJOR MINOR PERMIT TO OPERATE CHANGE IN CONDITIONS TO OPERATE 1 2 APPROVED CONSTRUCTION 3 4 WRITTEN MONITORING PROCEDURES 5 6 APPROVED MONITORING SYSTEM 7 8 MONITORING SYSTEM 9 10 APPROVED MONITOR FREQUENCY 71 12 MONITORING RECORDS MAINTAINED 13 14 ACCESS CASING SECURED 15 16 PIPING 17 18 INVENTORY RECONCILIATION 21 20 TANK GAUGING 211 22 APPROVED RESPONSE PLAN 2324 UNAUTHORIZED RELEASE OCCURRENCE 25 27 26 - - SAMPLING 28 APPROVED TANK REPAIRS 29 30 - UNAUTHORIZED RELEASES REPORTED 31 32 -- SAFETY HAZARD 33 34 CONDITIONS ABATED 35 36 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL FLAMMABLE VAPORS REMOVED �18 39 _ ACCESS LOCATIONS SEALED 40 POWER DISCONNECTED 41 42 OWNER/OPERATOR MONITORING 43 45 PERMANENT TANK CLOSURE ' REMOVAL OF RESIDUAL MATERIALS PIPING 46 47 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 m IMPROPER ABANDONMENT 55 56 SYSTEM STATUS(MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS FOLLOWS: /�, J NO 59 VIOLOR ❑ VIO57 58 MINLR ❑ VIOL. ❑ Gf R�il� --sh1��' OFFICE: INSP: .{�� ---- --------- 1� '� { L RECEIVED BY: TITLE PHONE: RECK: HUT-3 White-Original Yellow-Owner's Ca Pink mk-File Copy