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AGROUND TANK OFFICIAL INSPECTION ART <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> + Mailing Address: P.O.Box 388 <br /> COUNTY NAME SQ,1 Stockton,488342201-0388 COUNTY # <br /> SITE NAME: M n/� 1 N( INSPECTION DATE:��r l I (4q <br /> SITE ADDRESS: 1'-4S(p `� `, 1 `1so� CITY/STATE/ZIP ('&(W <br /> VV Cit 9SZCIS <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> O <br /> r� PER #(ZO -O\ PER # k300-L^� PER# PER# <br /> Z5 I S OO EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONreNTs <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 s <br /> WRITTEN MONITORING PROCEDURES 7 6 <br /> APPROVED MONITORING SYSTEM 9 70 <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 t5� C, ^tke <br /> TANK GAUGING 23 24 �+ <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 2g 3p <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 U4445 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED 3 <br /> 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 MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> OR El MOL .I <br /> VIOL, VOL.❑ <br /> OFFICE: INSP`/ <br /> :3 ERRS RECEIVED BY: <br /> TITLE: Lnx, HCCL " *CO PHONEn'f 7 / I RECK: <br /> 3 Write-Original Yellow-Owner's Copy oink-File Co v l"f G•t2 <br />