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AGROUND TANK OFFICIAL INSPECTION ROT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �4!5 N.San Joaquin street <br /> mailing Address: P.O.Box 388 <br /> Stockton,CA 95201-0388 COUNTY # <br /> COUNTY NAME 468�3420 <br /> SITE NAME: INSPECTION DATE: -3 <br /> SITE ADDRESS: 7r CITY <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPE TION SITE COMPUTER# PER # PER# PER# PER# <br /> se_)o EXP DATE EXP.DATE EXR DATE EXP.DATE <br /> TANK CON�N� <br /> OPERATIONAL TANK MAJOR Wil—NOR jo,Ct5i� C4 L I C) 01C� (At <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE F3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <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 is <br /> PIPING -io— <br /> INVENTORY RECONCILIATION 21 i2__ <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 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED W4142 <br /> POWER DISCONNECTED 43 <br /> 5 <br /> CWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 47 <br /> PIPING _49 <br /> FLAMMABLE VAPORS REMOVED m <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 1 1 1 <br /> THE MARKED ITEMP REPRESENT VIOLATIONS AND MUST BE CORRECTED As <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. �� VIOL. VIOL. <br /> OFFICE: INSP' E EIVED <br /> TITLE/ <br /> ,��5 PHONE: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5/88 (D <br />