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UN-.cRGROUND TANK OFFICIAL INSPECTION REPORT <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.Weber Ave.,Third Floor <br /> Mailing Address:P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201.0388 COUNTY # <br /> 468-3420 <br /> SITE NAME: _ INSPECTION DATE: I 2 <br /> U <br /> SITE ADDRESS: I_ CITY/STATE/ZIP <br /> xkc(Q��- <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK T TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER <br /> PER N PER PER PER <br /> -T EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS ! <br /> OPERATIONAL TANK <br /> MAJOR MINOR ,} .l '. '� �± ,.r1 Ilst. ti :,• I- _ <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 /> ;NVENTORY 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 REPAIgS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY IIAZARD 35 36 <br /> CONDITIONS ABATED 37 <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 TXNK CLOSURE `; I 'h;l <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 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUSE MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> NO <br /> VIOL R ❑ MINOVIOLR <br /> R ❑ VOL.❑ __ —-- --- — <br /> OFFICE: INSP: RECEIVED <br /> TITLE: S PHONE: 11 <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copv <br /> PHS 178 (4/96) <br />