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Uiv. (GROUND TANK OFFICIAL INSPECTION FI _ . _ AT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> M ENVIRONMENTAL HEALTH DIVISION <br /> 445 N- San Joaquin Street f <br /> COUNTY NAME Mailing Address: P.O. Box 388 <br /> Stockton, CA 95201 -0388 COUNTY # <br /> 468-3420 <br /> SITE NAMEG /IU � INSPECTION DATE: <br /> SITE ADDRESS: /—[ � 6e �ZV`�J j/i[;1eEITY/ STATE/ZIP �� G <br /> CHANGES SITE /OWNEER/ PERMIT? YES NO TANK / TANK TANK 7 TANK <br /> FORM A AND/ OR B SUBMITTED? COMPUTER COMPUTER 1 COMPUT �y�U COMP ^�� <br /> NUMBER/o NUMBER �QI O W NUMBED O NUMB 0 0 <br /> TYPE OF INSPECTION SITE COMPUTE #� PER <br /> # + O PER # jf PER # PER # C <br /> I, ii ({ JT EXP. DATE EXP. DATE EXP. DATE EXP. DAT <br /> OPERATIONAL TANK ---MAJOR IMNK reNTs <br /> 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 j <br /> POWER DISCONNECTED <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 56 <br /> THE MARKED ITEMS REPRESENT VCIO.LAyTIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS (MUST MARK ONE) FOLLOWS: ✓ / S <br /> MAJOR Sr MINOR 58 NO 59 p - <br /> VIOL. E:] VIOL. ❑ VIOL. - <br /> OFFICE: INSP: / . / w RECEIVED BY: <br /> TITLE:S�� PHONE: BECK: <br /> HI IT-51 White - Orlainal Yellow - Owner's Copy Pink - File Copy 5/88 <br />