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AGROUND TANK OFFICIAL INSPECTION REST <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTYALHEber �ALTH.Third DIVISION <br /> 3D4 E.Mailing Address:P.O.Bon 388 <br /> COUNTY NAME ' j -+QCI <br /> Stockton, <br /> CA95201-0388 COUNTY #3 <br /> 468-3420 <br /> SITE NAME: Yll 11 I y INSPECTION DATE: 7 <br /> SITE ADDRESS: 7 �, ( C9✓L. Imo/ CITY/STATE/ZIP S fo Cff - <br /> CHANGES SITE YES NO TANK I TANK '9— TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION yI SITE COMPUTER# PER # PER # PER # PER # <br /> r D u 'L,I- �/�'1 I �I( C-1-,3f `�D v EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL mRKcorneRrs <br /> MMAJ65MINORPERMIT TO OPERATE 2 <br /> CHANGE IN CONDITIONS TO OPERATE 4 <br /> APPROVED CONSTRUCTION 6 <br /> WRITTEN MONITORING PROCEDURES 8 <br /> APPROVED MONI TOTTING SYSI EM 10 <br /> MONITORING SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> r <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 I IAZARD 35 36 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE 1r <br /> REMOVAL OF RESIDUAL W14t2 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> - <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 <br /> •REPRESENT VIOLATIONS AND MUST BE CO�R9R�E�C�TE(�DyA(TS� <br /> SYSTEM STATUS(MUSr MARK ONE) FOLLOWS: y- ��,,/�` " <br /> cam_ <br /> 57 58 59 v <br /> VIOLOR ❑ VIOL. ❑ ' V OL.❑ <br /> OFFICE: NSP: �p �1 RECEIVED BY: 3 — d 97, <br /> p� u- \ e�-A s <br /> TITLE:v((`ft H.`s/ PHONE: BECK: <br /> HUT-3 While-Original Yellow-Owner's Copy Pink-File Copy <br /> PHS 178 (4/96) <br />