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I..'s-RGROUND TANK OFFICIAL INSPECTIONVART <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 Stoekton.CA 95201-0388 <br /> 468-3420 COUNTY <br /> SITE NAME: �\ INSPECTION DATE:1-2 <br /> SITE ADDRESS: (� ' i°M0.9 CITY/STATE/ZIP <br /> S. G <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK TANK tANK TANK <br /> FORM A AND/OR 8 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> NUMBER/!(,04-0/ NUMBER/LQ1/-6 NUMBERl4 c o 0.3 NUMBER 160q--;lo 11 <br /> PER# PER # PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK OPERATIONAL TANKTANKcor+TErrts .'� - <br /> MAJOR 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 FREOUENCY 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 135 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 -- <br /> ACCESS LOCATIONS SEALED 41 142 _ <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 144 145 <br /> PERMANENT TANK CLOSURE <br /> - ~ _1 `�,.. :1`..�isF�•�J:'I+.A� .elf C-�i�•.e�+'xNZi */U- .v,. <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 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MVIINOR V-�VIOL <br /> O 59 <br /> VIOL LiL ❑ <br /> OFFICE: INSP: �.1��� • RECEI BY: <br /> TITLE: i j.S PHONE: RECK: <br /> HUT-? +,Vhaq- _r^_:nal Yallow-Owners Coov oin!(.=;p 'taw <br />