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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545859
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Last modified
6/3/2020 5:09:49 PM
Creation date
8/15/2019 11:27:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545859
PE
3528
FACILITY_ID
FA0003831
FACILITY_NAME
WATERLOO FOODMART
STREET_NUMBER
4315
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215-2305
APN
08710034
CURRENT_STATUS
02
SITE_LOCATION
4315 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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UNDERGROU!', TANK PROGRAM OFFICIAL INSPF^•TION REPORT <br /> ' SAN JOAQUIN HEALTH DISTRIC- <br /> CC __ _L■� 1601 E. HAZELTON AVE. <br /> COUNTY NAME �Xf�ic'tSTOCKTON, CA L'lJ PHONE NO. 468-3423 COUNTY #5205 `j <br /> SITE NAME: If INSPECTION DATE: <br /> SITE ADDRESS: CITY/ST1 -s � fit C4 �IO j <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK C TANK bTANK 0'3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> NUMBER NUMBER NUMBER NUMBER <br /> j PER# PER# PER# PER#(o EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _0 <br /> APPROVED CONSTRUCTION 5 6 ©�C � /�� � <br /> ho <br /> WRITTEN MONITORING PROCEDURES_ 7 8 <br /> APPROVED MONITORING SYSTEM 9 110 <br /> (� <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 /> 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 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 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR a MINOR NO b9 <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: , RE ED BY. <br /> TITLE. / , PHO E: BECK: <br /> HUT-3 / 'ORIGINAL 5/88 OM <br />
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