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U*GROUND TANK OFFICIAL INSPECTION RaRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Boz 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY OUNTY # <br /> SITE NAME: n G 4� INSPECTION DATE: <br /> SITE ADDRESS: 7CITY/STATE/ZIP <br /> L-I D y FJ LJ e sF- L o.-�c <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK r— TANK 5r TANK w TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OFINSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> d/ PER# PER# PER# PER# <br /> /963 EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK TANK CONT NM 6 <br /> MAJOR MINOR /POO A11 o !/Oi907,5/e 0tolow JD;ese( 10(COO UL <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 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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL VIOL.❑ <br /> OFFICE: n f/Ar INSRECEI BY: <br /> i K l/` / <br /> o33y <br /> TITLE: �L /# PHONE: PECK: <br /> WIIT—Q Wnun-ndninnl V.11—n-0.c,...., <br />