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UORGROUND TANK OFFICIAL INSPECTION FRT <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 /> Stockto 468 3420 CA 1-0388 COUNTY # 5 <br /> SITE NAME: oI I c„� <br /> L INSPECTION DATE: <br /> SITE ADDRESS: - <br /> -J 2SSO we$} L4hg CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK <br /> FORM A AND/OR B SUBMITTED? TANK TANK <br /> COMPUTER / COMPUTER COMPUTER TANK <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER COMPUTER <br /> a PER# NUMBER <br /> d 23 12 l3 PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANxCONMAJOR MINOR TENTS lIC4 <br /> EXP.DATE <br /> I (S✓ <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 f <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN <br /> 25 26 l <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 47 E. <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 60 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> --------------- <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> MAJOR 57 MINOR 58 Np 59 <br /> VIOL. VIOL. El VIOL❑ <br /> OFFICE: INSP: <br /> R C g <br /> (,-70 o.33y J�- <br /> TITLE: PHONE: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy <br /> 5/88 (2D M <br />