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ORGROUND TANK OFFICIAL INSPECTION #RT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />6UNT1 NAME Stockton CA 95201-0388 enHUTV 4A <br />�68-3420 <br />A <br />SITE NAME: 1--7 INSPECTION DATE: <br />Acc�c r I FW -T ijfz± � <br />SITE ADDRESS: CITY/STATE/ZIP <br />REMOVAL OF RESIDUAL MATERIALS <br />CHANGES SITE/ovAER/PERMIT? ' YES V NO <br />FORM A AND/OR B SUBMITTED? <br />TA[VTANK <br />COMPUTER `7 <br />NUMBER <br />PER # <br />COMPUTER <br />NUMBER <br />PER # <br />TANK <br />COMPUTER� <br />NUMBER <br />PER # <br />TANK <br />COMPUTEP <br />NUMBER <br />PER # <br />TYPE OF 1 SPE N <br />SITE COMPUTER #/ <br />7- <br />UNAUTHORIZED RELEASE <br />51 <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />156 - <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />-1y 8 <br />.. ......... .. ........ <br />000 <br />.. ............ <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />vo� <br />Vo— <br />17 18 <br />ACCESS CASING SECURED <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27-j/ 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />331734 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />38 39 <br />40 <br />REMOVAL OF RESIDUAL MATERIALS <br />41 42 <br />PIPING <br />43 <br />49 <br />44 457 <br />50 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />m <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />156 - <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR <br />57 MINOR 58 O 59 <br />r --j V <br />VIOL. VIOL. L -J IOL. Lj <br />OFFICE: INSP:y <br />TITLE: 5r,. <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />e -e— /',O)A- /-Z r.,oe- <br />BECK: <br />,-7 <br />-ll- <br />1 — <br />