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U RGROUND TANK OFFICIAL INSPECTION F. !RT <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 COUNTY # <br /> 468-3420 <br /> SITE NAME: `� x INSPECTION DATE:" C� <br /> 4CHANSITE ADDRESS: 7 (� ( ` y� CITY/STATE/ZIP 64- <br /> CHANGES <br /> GES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER /, COMPUTER �7 COMPUT COMPUTER <br /> TYPE INSP TION SITE COMPUTER# PER BE/0)�v� pER NUMBER/ I'v PER P �5 PER 00 B��� <br /> EXP.DA EXP.DATC N EXP.DASE yr 1� EXP.DATE /� <br /> �.1t <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 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 44 145 <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 155 156 <br /> THE MARKEDLITEMS REPRES T VIOLATIONS AN MUST BE CQF43EaTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Y` <br /> MAJOR 57 MINOR 58 NO 9jm&kklee�i JIM L4 <br /> t , <br /> VIOL. ElVIOL. ❑ VIOL. <br /> OFFICE: INSF�:� j J� RECEIVED BY: <br /> TITLE: PHONE: 1� 3 3q ; BECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy /t,• 5/88 0 M <br />