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AGROUND TANK OFFICIAL INSPEC:TIONwe. AT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> a4S N.San Joacuin Street <br /> COUNTY NAME Nailing Address: P.O,sax sas <br /> stto 46a-3�'ossa COUNTY ># <br /> SITE NAME: <br /> INSPECTION DATE. <br /> I <br /> SITE ADDRESS: CRY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TA TANK ANK TANK I <br /> FORM A AND/OR 6 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> PER PER PERPER <br /> + 1 <br /> * f <br /> EXP.DATE EXP.DATE EXP.DATEEXP.DATE <br /> OPER TIONAL TANK TMK comrium ��_x L• }� <br /> MAJOR <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 /> - -. — - - -- <br /> MONITORING SYSTEM 71 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> -- _ - - <br /> - -- - <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> ACCESS CASING SECURED 17 18 - <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 122 - - <br /> TANK GAUGING 23 124 ---- -- --- — --- - - . - - - - .. <br /> APPROVED RESPONSE PIAN 25 26 _ ...._._..._....... ._ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 <br /> SAMPLING 29 m - --- <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> PLAMMABLE VAPORS REMOVED 4p <br /> ACCESS LOCATIONS SEALED 4142 <br /> POWER DISCONNECTED 43 <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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: S r -OF-2 <br /> 57 58 59 <br /> VIOL ❑ VIOLOR ❑ VIOL❑ <br /> OFFICE: 1INSP. (RECEIVED BY: <br /> Wad <br /> TITLE. ( � PHONE: (RECK: <br /> .vnite-Onacst Yauow•Owners Cooy 3tnft-.-.re Caov ..,� <br />