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U&GROUND TANK OFFICIAL INSPECTION AT <br /> EN JOAUIN PUBLIC HEALTH SERVICES <br /> NVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # 3 <br /> 468-3420 <br /> SITE NAME: S v� INSPECTION DATE: <br /> I ' <br /> SITE ADDRESS f ), ITY/STATE/ZIP �+ <br /> CHANGES SITE/OWN /PERMIT? YES NO NK , ANK ?/ TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUT COMPUTE COMPUT� COMPUTER <br /> TYPE OF SPECTION SITE COMPUTER# I NUMBER'0G UMBERPER # PER �U/y&I NUMBER NUMBER <br /> / J EXP.DP EXP.DATBI�" v PER# PFR# <br /> � EXP. E0/ � DATE <br /> OPERATIONAL TANK MNKCONTEN+ <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 v <br /> APPROVED MONITORING SYSTEM 9 10 T _� <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 x �Ix J� <br /> INVENTORY RECONCIUATION 21 22 / v <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 OLC'fJL, J J/� `�(J J n <br /> SAMPLING 53 54 �7 O �Y r <br /> IMPROPER ABANDONMENT 55 56 ii <br /> THE MARK 1 MS REPRESENT VIOLATIONS AND MUST BE CORRECTEDk <br /> to <br /> SYSTEM STATUS IMUST MARK ONE) FOLLOWS: • U <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL. Q w {'W <br /> u <br /> - h <br /> OFFICE: INSP: RE!17 EIVED BY: <br /> ' TITLE: L&4 PHON RECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/68 OM <br />