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OP 3 <br /> UN% .AGROUND TANK OFFICIAL INSPECTION R&,RT t/ <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 NAME Stockton,CA 95201-0388 <br /> 468-3420 COUNTY # <br /> SITE NAME: ` � IupvkjNSPECTION DATE: 6-�3-1y <br /> SITE ADDRESS: I ITY/STATEl r C�- /S--2-I� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 1 �� TAN TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER CO PUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER oloif) j� NUMBER NUMBER NUMBER <br /> �'y�C y�, PER # // G, [[,, VV1I PER # PER # PER# <br /> .TAW K (/ EXP.DATE l�I XP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONT[N15 <br /> MAJOR MINOR <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 79 20 <br /> INVENTORY RECONCILIATION 21 22 _ - <br /> 7ANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 <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 36 3 <br /> 4p <br /> 41 42 <br /> q3 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 46 49 <br /> cLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 58 MINOR NO 591.4 IZ4 >✓ za00 /`IL <br /> VIOL. ❑ VIOL. ❑ VIOL t <br /> OFFICE: INSP:G ' RECEIVED BY: <br /> TITLE PHONE: <br />