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*RGROUND TANK OFFICIAL INSPECTION R # T <br />SAN JOAOUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave. Third Floor <br />Mailing Address: P.O. So. 388 <br />COUNTY NAME Stockton, 68-3420 CA 95201-0388 COUNTY # ZC- <br />4 <br />SITE NAME* INSPECTION DATE: Aly-4 -I T je 90, 4C <br />SITE ADDRESS: A 7_ 7 1 . n.., .d W- CITY/STATE/ZIP <br />4 <br />CHANGES SITE/OWNER/PERMIT? YES —NO TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # /0/00 <br />Z_ EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER 0 <br />PER <br />EXP. DATE <br />TANKTANK <br />COMPUTER -5 <br />NUMBER OM <br />PER <br />EXP. DATE <br />COMPUTER <br />NUMBER <br />PER <br />EXP. DATE <br />OPERATIONAL TANK <br />TAM CONTENTS <br />46 <br />Wj6fi I M06ii <br />1 2 <br />48 <br />PERMIT 10 OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />55 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />Fgv" <br />APPROVED MONITORING SYSTEM <br />To.— <br />MONITORING SYSTEM <br />11 0112 <br />APPROVED MONITOR FREOUENCY <br />13 14 <br />Vol <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 1 18 <br />PIPING <br />19 ;20 <br />INVENTORY RECONCILIATION <br />21 J/ 22 V11, <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 6 <br />13_, <br />I <br />CONDITIONS ABATED <br />1100 <br />TEMPORARY TANK CLOSUI <br />AEMOVAL OF RESIDUAL' <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />IF <br />x <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />I <br />,ARM, <br />Zi <br />'14 n <br />N <br />46 <br />47 <br />49 <br />m <br />52 <br />54 <br />56 <br />48 <br />50 <br />51 <br />53 <br />55 <br />I <br />THE MARKED ITEMS REPHESEN I VIULAP IUNZj ANU rAU,31 br- kU"HrU I r -LJ MO <br />(STEM STATUS (MUSI MARK ONE) <br />57 58 <br />MAJOR MINOR No 59 <br />tr-i <br />VIOL. LV VIOL. 0 VIOL. " <br />OFFICE: [f <br />TITLE: <br />HUT -3 white - original yellow - owner's Copy Pink - File Copv <br />PHS 178 (4/96) <br />N <br />46 <br />47 <br />49 <br />m <br />52 <br />54 <br />56 <br />48 <br />50 <br />51 <br />53 <br />55 <br />THE MARKED ITEMS REPHESEN I VIULAP IUNZj ANU rAU,31 br- kU"HrU I r -LJ MO <br />(STEM STATUS (MUSI MARK ONE) <br />57 58 <br />MAJOR MINOR No 59 <br />tr-i <br />VIOL. LV VIOL. 0 VIOL. " <br />OFFICE: [f <br />TITLE: <br />HUT -3 white - original yellow - owner's Copy Pink - File Copv <br />PHS 178 (4/96) <br />