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UN SiGROUND TANK OFFICIAL INSPECTION RE1w IT ail[ SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL� �rHA HEALTH DIVISION Meiling Address:P.O.Boz 3" COUNTY NAME Stockton,CA 9201 COUNTY # -3F1 SITE NAME: r INSPECTION DATE: ' SITE ADDRESS: Arc,I 1w CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES O 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 R PER# PER I PER / EXP.DATE EXP.DATE EXP.DATE EXP.DATE mrm conreRn `i`�;`r, l � ;•%r•:" �" '�7�6°@ ,{tt�S ' 'Y OPERATIONAL TANK wiA.iop xnNOR 1 PERMIT 10 OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8V/ APPROVED MONI IORING SYSI EM 9 ID MONITORING SYSTEM 11 12 V �_ APPROVED MONITOR FREQUENCY i3 14 ✓v/// Z51- MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 IB PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 7,,J•y' UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 737 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL &44t FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE 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 VIOLATI�OJsS.AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) 1 FOLLOWS: _ 57 58 59 OL ❑ VIOL. ❑ VIOL.❑ OFFICE: INS RECEIVED BY: TITLE:';PV ✓,..)G PHONeod-3 _ F.? BECK: HNT-3 While-Odgin8l Yellow-Owner's Copy Plnk File Cop, L_J Y r PHS 179 (4196)