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Hazardous Waste Tank System <br />Written Assessment per CCR Title 22 <br />Stockton CSMS. Stockton. CA <br />Page l of <br />Integrity Assessment Inspection Checklist <br />G,:iwral Information <br />Site Name: Facility Contact: Contact Tel No.: Date <br />Site .Address: <br />Street 4D c3 AAd City: 12--/ Zip:.9-s/1--" <br />Tank Contents: <br />cc.* op AVPI/ P;;t4E0;&K- <br />Ta k Id (if ny) G s Caaci,t <br />rAt <br />Yr Installed: <br />d <br />Tank �Tfg.: <br />/oX s'w'e- <br />Tank Model: <br />�-- <br />i, <br />Tank Configuration (long. dimen.) <br />Dimensions: <br />❑Ilorizcmtalt (Vertical <br />Rectangular Tanks: L:__ Nk H: <br />C'vlindrical Tanks: Length, Gf- Diam. —V <br />Secondary Containment <br />Tank: r Integral DW Tank ❑ Containment berm ❑ Controlled Drain/Sump ❑ None <br />❑ Other <br />Piping: ❑ Integral DW Piping ❑ Containment berm ❑ Controlled Drain Sump ❑ None <br />X) Other (description) <4V#'V t 7'X 0 4-&d`i <br />Tank Primary Containment Material Steel ❑ Fiberglass ❑ Other Wall Thickness <br />� <br />Tank Secondary Containment Material 13 Fiberglass F-1 Other _ Wall ThicknessAl ❑ None <br />�_2"SSteel . <br />Piping Primary Containment Material E teel ❑ Fiberglass ❑ Other Diameter (in.) <br />Piping Secondary Containment Material ❑ Steel ❑ Fiberglass ❑ OtherDiameter (in.) ❑ None <br />D"criptionlCom ments: <br />Usher Equipment , w pxv /'►(� f <br />❑Pump. Internal (type, size) (]Pump, External (type. size)_ r% b <br />01)m,Tank ❑Drain Table ❑FiiterCrush ❑Ocher _ ®Clectronic Monitor(MfW Model) <br />Description/comments: <br />I)wg'9 Available ❑ Yes ❑ No <br />a <br />19 Tank inside Building or Covered! <br />❑Yes ❑ No <br />Leak Test or Inspection Avail? <br />❑ Yes ❑ No If Yes. Date <br />Placard Labeling <br />❑((( Present ❑ No Smoking 6'' Pmlucl Description Ff Hazardous Waste <br />< <br />Absent 1AIW Accum Start Date 1% UL Std No. [/ b ❑ Other <br />Off <br />Strandberg Associates 1(866) 388-0404 (650) 329-8918 rwaterguy(cD- waterguy.com A-5 <br />