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U, RGROUND TANK OFFICIAL INSPECTION RE. AT <br /> " SAN JOAQUIN 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 95201-0386 COUNTY # <br /> D t e• 468-3420 <br /> SITE NAME: �,. INSPECTION DATE: it i" <br /> SITE ADDRESS: 53 l pa-o — -S-74, CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK 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 # PER # PER PER # <br /> ' EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR ti-` r y Iw;C ;' i <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 TA A) L <br /> WRITTEN MONITORING PROCEDURES 7 8 S f.411C OL <br /> APPROVED MONITORING SYS IEM 9 10 1.;" base <br /> MONITORING SYSTEM 11 12 re /nom y• Ac m <br /> APPROVED MONITOR FREQUENCY 13 14 �� 5� <br /> �— ,,ft 'fir <br /> � �q- � <br /> MONITORING RECORDS MAINTAINED 15 16 L # <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 co 4&-. <br /> :NVENTORY RECONCILIATION 21 22 1q. c*;spit." <br /> TANK GAUGING 23 24 _ Ae"On O A <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> �.. <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAITjS 31 32 �Y [•� <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY IIAZARD 35 36 <br /> CONDITIONS ABATED F37 <br /> TEMPORARY TANK CLOSURE J u a; r ;7 r t j '• '}"t'9�m,&' <br /> d T1 ' <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 /> p.#11m. ik"AIS`HY 1 `• t +r tl I r 1 I a ! <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 /> a <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: - <br /> 57 58 590 1 ._S . �. <br /> r--a ,�-i7--- <br /> MAJOR MINOR NO � � �� ' '- <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ <• ;i , _1 .. ;4 <br /> OFFICE: INSP, , RECEIVED BY: <br /> TITLE: r', i �/ PHONE: BECK <br /> HUT-3 White-Original Yellow•Owner's Copy Pink-File Copv <br /> PHS 178 (4/96) <br />