Laserfiche WebLink
UI s,.,AGROUND TANK OFFICIAL INSPECTION RL�RT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailin <br /> COUNTY NAME a St ckton,rCA 95201 038888 �`QU�YE <br /> 468-3420 <br /> SITE NAME: �� INSPECTION DATE: <br /> a <br /> SITE ADDRESS: w CITY/STATE/ZIP 's 4,4,-j <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER' ' NUMBER NUMBER NUMBER <br /> �? PER# ,����0 PER# PER# PER# <br /> V D,v u—' �ps-Z-- EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS �. `j '>s <br /> OPERATIONAL TANK 4 <br /> MAJOR MINOR71 <br /> F <br /> PERMIT TO OPERATE 1 2 1 <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 /> Asa 3 <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 45 <br /> RMANENT TANK CLOSURE <br /> RE ESIDUAL MATERIALS 46 147 <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS; U <br /> MAJOR Q MINOR NO 5L J <br /> VIOL. VIOL. VIOL.u <br /> OFFICE: INSP: RECEIVED BY: <br /> rTLE: PHONE: BECK: <br /> tJ11T__7 <br />