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t U <br /> GROUND TANK OFFICIAL INSPECTION RIRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> COUNTY NAME 445 N.San JoaquinStre <br /> Mailing Address: P.O.I3oxet <br /> 388 <br /> Stockton,CA 95201-0388 <br /> SITE NAME,- 468-3420 <br /> S� COUNTY # <br /> SITE ADDRESS: <br /> Z,3 INSPECTION ATE: <br /> INSPECTION DS . <br /> CHANGES SITE ,I ',i NER/pERMIT� CITY/STATE/z+R <br /> FORM A AND/OR g SLjBMITTED`� ES NO <br /> TANK 1 <br /> TYPE OF INSPECTIO COMPUTER 7 TANK TANK <br /> COMPUTER# NUMBER COMPUTE♦ TANK <br /> i/ NUMBER COMPUTE <br /> PER# NUMBER COMPUTER <br /> TAPER# <br /> OPERATIONAL TANK EXP.DATE PER# NUMBER <br /> NK CONTENTS <br /> EXP.DATE PER# <br /> PERMIT TO OPERATE MAJOR MINOR EXP.DATE <br /> EXP.DATE <br /> CHANGE IN CONDITIONS TO OPERATE 1 2 J <br /> APPROVED CONSTRUCTION 3 4 <br /> WRITTEN MONITORING PROCEDURES 56 <br /> APPROVED MONITORING SYSTEM 7 8 <br /> MONITORING SYSTEM 9 10 <br /> APPROVED MONITOR FREQUENCY 11 12 <br /> 14 <br /> MONITORING RECORDS MAINTAINED 13 <br /> ACCESS CASING SECURED 15 16 <br /> PIPING 17 18 <br /> INVENTORY RECONCILIATION 19 20 <br /> TANK GAUGING 21 22 <br /> APPROVED RESPONSE PLAN 23 24 <br /> 25 __-- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 <br /> SAMPLING - <br /> 29 30 - <br /> APPROVED TANK REPAIRS 31 <br /> - _ - <br /> AUTHORIZED RELEASES REPORTED 32 <br /> _ <br /> SAFETY HAZARD 34 <br /> - <br /> CONDITIONS ABATED 35 37 36 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAI.OF RESIDUAL <br /> FLAMMABLE VAPORS REMOVED 0 39 <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED 41 42 <br /> OWNER/OPERATOR MONITORING 43 <br /> 4445 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS <br /> PIPING 46 47 <br /> FLAMMABLE VAPORS REMOVED 48 49 <br /> 50 <br /> UNAUTHORIZED RELEASE <br /> SAMPLING 51 52 <br /> IMPROPER ABANDONMENT 53 54 <br /> 55 56 <br /> SYSTEM STATUS(MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS: <br /> MAJOR 57L! Q�MANOR 58 <br /> VIOL. VIOL. L~J <br /> VIOL. <br />!FFICE; INSP: - <br /> C ED BY.- <br /> TITLE: PHONE: <br /> v BECK: <br /> SIRA <br /> ti�1. 1 \ �6�5Mjnk F'cla Ce�v <br />