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UNNIERGROUND TANK OFFICIAL INSPECTION RbPl6RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME �' Mailing Address: -038366 COUNTY #, <br /> Stockton,CA 952015201-0388 <br /> 468-3420 <br /> SITE NAME: .} G INSPECTION DATE:,3.� —I T <br /> SITE ADDRESS: / CITY/STATE/ZIP � /X44 G4 '?-%D <br /> CHANGES SITE/OWN/ER/PERMIT? YES NO IrANK 3 TANKTANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPU R COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> O U I I 16, 31919 PER <br /> DATE EXP.DATL EXP.DATE EXP.DATE <br /> OPERATIONAL TANK Tarot C01MNTS ". <br /> MAJOR MINOR <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 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 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 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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 v <br /> VIOL R ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: if A r RECEIVED BY: <br /> TITLEcE15 b PHONE BECK: <br /> S <br /> HUT-3 White.Original Yellow-Owner's Copy Pink-File Copy 5/88 O M <br />