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AGROUND TANK OFFICIAL INSPECTION AT <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, 95201-0388 COUNTY # <br /> 488-8-3420 <br /> SITE NAME: / I INSPECTION DATE: <br /> SITE ADDRESS: q�D V/ W� CITY/STATE/ZIP L ppy��d— <br /> CHANGES SITE YES NO TANK 1 TANK aZ TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBERNUMBER /��' NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# e5 � Aim _ <br /> PER # rN PER # PER# PER # <br /> J EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK r X CON NE <br /> MAJOR MINOR <br /> PERMIT TO OPERATE dJ 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 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 21 122 <br /> TANK GAUGING 23 124 <br /> APPROVED RESPONSE PLAN 25 126 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <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 <br /> REMOVAL OF RESIDUAL R4445t <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 I <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS <br /> ANDD f/��UST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: /lj I , RECEIV <br /> TITLE: �2� / PHO LTJ -3 R CK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br />