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UORGROUND TANK OFFICIAL INSPECTION ART <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL WEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 3$8 _3? <br /> COUNTY NAME "' a Stockton,asCA 42a01-a3a8 COUNTY <br /> SITE NAME: `ro �� �C I L'C'I~7`�yt� INSPECTION DATE: �r k <br /> SITE ADDRESS: / o I 's l�.� W CITY/STATE/ZIP d-fC)OK � <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK f TANK ;k-. TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUT <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER # PER# <br /> roue ►,L_e- X31 _ <br /> .DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTE <br /> EXP <br /> NTS S �° <br /> OPERATIONAL TANK MAJOR MINOR Ukoht. 4_ f <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 11 112 !le <br /> APPROVED MONITOR FREQUENCY 13 14 p ] <br /> MONITORING RECORDS MAINTAINED 15 16 �1 , -71 I a <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 � <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 124 <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 PER 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 /> F <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 1156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED A5 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: - <br /> 57 58 59 - <br /> MAJOR MINOR NO — -- <br /> VIOL. ❑ VIOL. ❑ VIOL <br /> OFFICE: INSP: ,, aa -. RECEIVED BY' I <br /> TITLE: i� ��frR-5 PHONE: PECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy r xis Om <br />