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U RGROUND TANK OFFICIAL INSPECTION R. SRT <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 5� ,� �Q� Stockton,CA 95201-0388 112468-3420 COUNTY <br /> SITE NAME: a �c --Q INSPECTION DATE. <br /> SITE ADDRESS- <br /> _30 S �% `� � CITY/STATE/ZIP--- �� <br /> CHANGES SITE/!OWNER/PERMIT? YES NO TANK TANK ,1 TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF IN P CT SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br /> NK S <br /> TA3 I g/ PER # PER # PER # PER t <br /> CO EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS �a�apa g ��OBS <01�000 <br /> MAJOR MINOR D_ (,L <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 9 110 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 c� <br /> PIPING tG i� 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 HAZARD 35 36 <br /> CONDITIONS ABATED VZ37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 /> 57 58 59 <br /> MAJONO <br /> VIOL. ❑ VIIOLL..R ❑ VOL- ❑ <br /> OFFICE. INSP� �� RECEIVED BY: <br /> �l4 <br /> TITLE:S�/U d�' PHo � -� BECK: <br /> HUT-3 ✓unite-Original Yellow-Owner's C py Pink-rile Coov <br />