COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

UWGROUND TANK OFFICIAL INSPECTION R&T SAN JOAOUIN PUBLIC HEALTH SERVICES ENVIRONMEN.VL HAEBALTF DIVISION 304Eberr Mailing Address:P.O.Box 388 COUNTY NAME Stockton,CA 95201-0388 COUNTY # 468-3420 SITE NAME: \ INSPECTION DATE: J SITE ADDRESS: CITY/STATE/ZIP CHANGES SITE/OWNER/,PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER ,f PER 4 PER PER T PER 1 EXP DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK COMENT9 wj& MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 V APPROVED CONSTRUCTION F—I 6 WRITTEN MONITORING PROCEDURES 8 APPROVED MONI TORING SYS]EM 10 MONITORING SYSTEM APPROVED MONITORFREQUENCY 14 MONITORING RECORDS MAINTAINED I6ACCESS CASING SECURED I8 PIPING 20 INVENTORY RECONCWATION 22 _ TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 APPROVED TANK REPATIS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 _ CONDITIONS ABATED 37 _ — - r tt TEMPORARY TANK CLOSURE ft A:,i,TM 1 ; .r. 414 REMOVAL OF RESIDUAL' W44t45 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE z REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS D MUST BE CORRECTED AS SYSTEM STATUS(MUSt MARK ONE) FOLLOWS: 06 C� — --'— V 58 NO 59 IOL R LJ VIOL. ❑ VOL.❑ --_._____....__-_.___—_. OFFICE: INS ECEIVED BY: TIT ,�f! PHO! NE: BECK: LE: HUT-3 While-Origlnal Yellow-Owner's Copy Pink-File Copy PHS 178 (4/96)