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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 NAMEStockton, CA 95201-0388 <br />i�.r✓ Ara_IA�n COUNTY # _-3q <br />SITE NAME: �j�6 /7 <br />�/�� _ <br />INSPECTION DATE: <br />SITE ADDRESS: � ,/�I <br />� /�jCIT /STATE/ZIP <br />CHANGES SITE /OWN`ER/PERMIT? <br />YES <br />TANK <br />TANK <br />TANK <br />TANK�7 <br />FORM A AND/OR B SUBMITTED? <br />— <br />COMPUTER V� <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION/SITE <br />COM TER # <br />PER# <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATION TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 112 <br />APPROVED MONITOR FREQUENCY <br />13 114 <br />MONITORING RECORDS MAINTAINED <br />15 116 <br />ACCESS CASING SECURED <br />17 118 <br />PIPING <br />19 120 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 132 <br />UNAUTHORIZED RELEASES REPORTED <br />33 134 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />EMPORARY TANK CLOSURE <br />RE OF <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJORMINOR NO <br />❑ ❑ <br />_ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSPY <br />146tdA�alv�� <br />_ <br />RECEIVED BY: <br />- <br />TITLE: d/ �Q...� <br />PHONE: <br />BECK: <br />�� 1 <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv 5/88 n M <br />