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UNOGROUND TANK OFFICIAL INSPECTION AT <br /> SAN JOAQUIN PU13LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address; P.O.Box 388 <br /> Stockton,CA 95201-0388 COUNTY # <br /> COUNTY NAME _ 46e-3420 <br /> INSPECTION DATE: <br /> SITE NAME: <br /> CITY/S TE ZiP37Z <br /> SITE ADDRESS: TANK TANK <br /> TANK TANK COMPUTER <br /> CHANGES SITE/OWNER/PERMIT? YES NO COMPUTER /} COMPUTER COMPUTER NUMBER NUMBER <br /> FORM A AND/OR B SUBMITTED? NUMBER(! NUMBER <br /> PER# PER # PER # <br /> SITE COMPUTER# PER <br /> TYPE O SPECTION - <br /> -5775 EXP.DATE EXP.DATE EXPDATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 <br /> 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 /> 19 20 <br /> PIPING <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 47 <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 VIOLATION S ND MUST BE CORREC E L <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> c <br /> 57 MINOR 58 NO 59 <br /> 11 <br /> MAJOR -- <br /> VIOL. VIOL. � V10L.11� <br /> INSP�'� RECEIVED Y. I <br /> OFFICE: rr <br /> PHONE: RE <br /> �( TITLE: C�3-6 �IrJ '1 �c'?� <br /> o J 5/aa <br /> ui rr—o whim-nriainal Yellow-Owner's Copy Pink-File Copv <br />