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ARGROUND TANK OFFICIAL INSPECTI ONART <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 Stockton, CA 95201.0388 <br />468.3420 COUNTY <br />SITE NAME: INSPECTION DATE: <br />SITE ADDRESS: CITY/STATE/ZIP <br />CHANGES SITE/ YES NO TKNK TANK TANKTANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTAI COMPUTER <br />TY OF IN PECTIO - NUMBF4B, NUM NUMB NUMBS <br />, (�; N <br />N SITE COMPUTER # PER #) PER yl� 7 <br />PER VR'eao PER # Z'ao <br />0 4 q J-7 EXP. DATE EXP. DATE EXP. DATE EXP. DAT E V <br />jjnMAI <br />T <br />AMIC TA CONTENTS <br />OPERA11ONAL TANK gg' <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 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 />...... --- <br />SAMPLING 29 30 <br />---- <br />APPROVED TANK REPAIRS 31 32 <br />UNAUTHORIZED RELEASES REPORTED 33 34 <br />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED M43 <br />OWNER/OPERATOR MONITORING 44 145 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />mm <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 59 <br />o <br />MAJOR MINOR <br />L 110 <br />VIOL. ❑VIOL. -J VIOL.191 <br />OFFICE: INSP. �uA41 <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copy <br />THE MARKED ITEM§ REPRESENT VIOLATIONS AND MUST BE CORRECTEDAS <br />6 <br />Ez <br />:--7,6 Of_ <br />