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L ERGROUND TANK OFFICIAL INSPECTION RPT SAN SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 E.Weber Ave.,Third Floor Mailing Address:P.O.Box 388 COUNTY NAME Stockton,CA 95201-0388 COUNTY # 468-3420 SITE NAME: 1 I s A Gln INSPECTION DATE: SITE ADDRESS: , ' ' I• CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER * PER PER PER PER # IJ EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR ry PERMIT TO OPERATE 1 2 GRANGE IN CONDITIONS TO OPERAIE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYS IEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREOUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY I IAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSUREi + REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTEDq45 OWNER/OPERATOR MONITORING 44 PERMANENT TANK CLOSURE 4 `r ; h1u fir. T , iyvi ..'t 1, REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55056 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:_ E�--��z ----- 57 58 59 VIOL.R [j VIOL.MINOR ❑ NO VOL.❑ ---__ -- — OFFICE: INSP: RECEIVE TI TLE: PHONE: BECK: I IUT-3 While-Original Yellow-Owner's Copy Pink-File Copv PHS 178 (4/96)