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UNORGROUND TANK OFFICIAL INSPECTION RET <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 52COUNTY <br /> COUNTY NAME y� D Stockton,CA9fl1•[l 9e <br /> ase-3420 <br /> 952 <br /> SITE NAME j�r ( � r )I U INSPECTION DATE: o8- <br /> SITE ADDRESS: r -S+ r ` -S �J CITY/STATEIZIP 5 c, � <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ! TANK .. TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPITER <br /> (#��( PER # PER# PER # PER # <br /> EXP,DATE 1 EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> M71 <br /> PERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES 65 ciL <br /> APPROVED MONITORING SYSTEM r13 <br /> 10 J� yygJ-�� <br /> MONITORING SYSTEM 12 r r'��m4"~ <br /> APPROVED MONITOR FREQUENCY O'� <br /> 14MONITORING RECORDS MAINTAINED 1�+� 16 <br /> ACCESS CASING SECURED O%K' 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 129 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> T�I Y)akjC1 Re S pgo-n cibi-h re 6__1 <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 148 149 <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 /> 59 <br /> MAJOR r 67 MINOR n NO <br /> VIOL. LY VIOL LJ VIOL. <br /> OFFICE: INSP � ECEIVPD�ABY�: <br /> _ V"v` <br /> TITLE: l1 a►` -�� PHONE_ RECK <br /> HUT-3 WhAe-Original Yellow-Owner's Copy Pink-File Copy S� F� <br />