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cRGROUND TANK OFFICIAL INSPECTIOI. ORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 an So P.O.N.Address: Street <br /> MailingSan P. Box t <br /> COUNTY NAME Stockton, CA 95201 -0388 COUNTY # <br /> 488-3420 <br /> SITE NAME: INSPECTION DATE D� Z 6�I <br /> SITE ADDRESS: Ci �r4 `TrGILs� CITY/STATE/ZIPS�� Gl '9� / <br /> CHANGES SITE/OWNER/ PERMIT? YES NO TANK TANK �7 TANK TANK 1 <br /> FORM AAND/OR B SUBMITTED? COMP / OMPUTE !/ COMP R COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER # NUMBER UMBER . N7 PER # �dh/1 NUMBER <br /> ✓�� PER # � PER # Jr � PER # 11�� PER # <br /> EXP. DATE OLM EXP. DATE XP. DATE EXP. DATE <br /> OPERATIONAL TANK TANK CONTEN S <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 _ <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> I ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 _ <br /> i INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> I 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 /> i <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED _ <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <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 i <br /> SAMPLING 53 64 1 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOL'AT!/�(�J^S AND MUST BE CORRECTED AS <br /> SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 56 NO 59 <br /> VIOL. LJVIOL. ❑ VIOL LA <br /> OFFICE: INSP: n RECEIVED BY: <br /> 5 <br /> I� TITLE: /J PHONE: RECK: <br /> F HUT-3 White - Original Yellow - Owner's Copy Pink - Flle Copv ../J <br />