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UIQDERGROUND TANK OFFICIAL INSPECTION REWbRT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME MaIling Stmkton,rCA95201-0388388 201038888 <br /> tt 468-3420 COUNTY # <br /> SITE NAME: ' INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP ��C0 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK ;2-, TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYjPF,PF IN�SPE�C�TIOjNI� SITE COMPUTER# PER# PER# PER # PER# <br /> D`� `^� �L✓ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK <br /> TANK coNrENrs <br /> MAJOR MINOR * :t �'f i ; + <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 -r,41 J k, <br /> WRITTEN MONITORING PROCEDURES 7 8 a,— a—4 q k Q 1 01I <br /> APPROVED MONITORING SYSTEM 9 10 t4e, 1 <br /> MONITORING SYSTEM 11 12 �R�K s I reS pi Dr <br /> APPROVED MONITOR FREQUENCY 13 14 _i0 �r t-01 r +(dy <br /> MONITORING RECORDS MAINTAINED 15 16 ff__ � Cdd- G <br /> ACCESS CASING SECURED 17 18 LV4,.T�'A IV <br /> PIPING 19 20 k • II 11 <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 /> .;< <br /> REMOVAL OF RESIDUAL R44457 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE :+ +x �` <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAOJOR LiVIOLR Li VIOL.❑ <br /> t _ <br /> OFFICE: INSP: <br /> �f IT(7 DAO ti� r A �-r <br /> aa3o9 <br /> TITLE:SEN 1 OR. r` E H S PHONE <br /> HUT-3 White-Original Yellow.Owner's Copy Pink-File Copy <br /> ,!nP <br />