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UNDF,..,ROUND TANK OFFICIAL INSPECTION REPW*f <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 an S <br /> N. Joaquin t <br /> Mailing San o P.O.Box Boz 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: INSPECTION DATE. <br /> SITE ADDRESS: ry, / 1� . �Tj� f}�jY{�STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO / TANK / T✓ANNKK' TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPU Eft COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUT R# NUMB h b� NUMBER NUMBER NUMBER <br /> PER # C� PER # PER # PER# <br /> OVA EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK TANK CONn N� .. <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 R43! <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 BUST BE CO ECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ' D <br /> MAJOR 57 MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL58 59 <br /> OFFICE: INS J RECEIVED BY: <br /> TITLEEJ7 r iC J�< PHO �v RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink`-File Copy -J S/W O M <br />