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11.14GROUND TANK OFFICIAL INSPECTION RET w <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.11388 <br /> COUNTY NAME Stockton,CA 95201.0388 COUNTY # <br /> 488-3420 <br /> SITE NAME: v O V iJ C C lT`( O F 29C1-( INSPECTION DATE: <br /> SITE ADDRESS: ��O tUC1 CITY/STATE/ZIP <br /> CHANGES SITE 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 /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER# PER# <br /> I\OUTtt, M z K- EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON NTS Q K USP 8t( (,.-{L /4 <br /> MAJOR MINOR O 1` <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 N Ll 1L T "sv� <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 Iv <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 _ <br /> APPROVED RESPONSE PLAN 25 26 ` ' 1 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 ��`.t� t' 111 jZ,� <br /> SAMPLING 29 30 ` <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 - <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4142 <br /> FLAMMABLE VAPORS REMOVED <br /> ACC ESS LOCATIONS SEALED 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 VIOLA IONS AND MUST E JYO/jRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: B ' ` 1�V�f <br /> anc�Are <br /> 57 58 59 <br /> NO <br /> VIOL R LJVIOLL..R ❑ VIOL.E] <br /> 6 <br /> OFFICE: INSP: RECEIVED BY: <br /> LCY <br /> TITLE' �^ UN BECK: <br /> H!IT-3 White-Original Yellow-Owner's Copy Pink-File Copy ;�r.a <br />