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UNDERGROUND TANK OFFICIAL INSPECTION REPORT <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 ),,, COUNTY # Stockton, CA 95201-0388 <br />�/��—121��1 (J //1% 46R -149n 79 <br />SITE NAME: <br />INSPECTION DATE: <br />SITE ADDRESS: / /)G CITY/STATE/ZIP <br />,4ve�,ZL lJ d�/Z <br />(� r /,15 <br />T <br />CHANGES SITE/OWNER/PERMIT? YES <br />TANK <br />TANK <br />TANK <br />TANK <br />FORMA AND/ORB SUBMITTED? <br />COMPUTER 01 <br />COMPUTER <br />COMPUTER 03 <br />COMPUTER Q� <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYP OF INSPECTION <br />SITE COMPUTER # <br />�//-- <br />(0 <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONA TANK TANK CONTENTS <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 />ACCESS CASING SECURED 17 18 <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 HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE <br />REM 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 155 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />57 5859 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: �i��� <br />PHONE: <br />BECK: <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv f 5/88 Ci M <br />