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UI!!&GROUND TANK OFFICIAL INSPECTION AART <br /> SAN JOAOUIN PUSLIC HEALTH SERVICES <br /> ENVIRONMEHNTTAAL L DIVISION <br /> amall <br /> =iffy UK "w W, C% i <br /> i <br /> f SITE NAME: r/ to v t INSPECTION DATE: <br /> SITE ADDRESS: <br /> 'vd�� g, ,.�,�1 3«o, 20t cITY/sTATE/ZIP S- <br /> ES SITE/OWNER/PERMIT? YES NO TANK 5 TANK TANK TANK a <br /> ORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER* NUMBER NUMBER NUMBER NUMBER <br /> PER* PER* PER* PER* <br /> o�'}-t EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK <br /> tw►ro� tmlNon - ��,r �, � ; <br /> PERMIT TO OPERATE 1 12 <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 MAfNUWIED 15 18 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 <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 135 136 <br /> CONDITIONS ABATED 37 _ <br /> TEMPORARY TANK CLOSURE '. <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 L� <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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 t/ <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> VIOMINOR NO <br /> L R ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP. RECEIVED BY: <br /> No G <br /> PHONE: BECK: <br /> HUT-3 White-Oriainel Yellow-Owners Coov Oink-Flie rnnv <br />