Laserfiche WebLink
U GROUND TANK OFFICIAL INSPECTION ROT <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 COUNTY # <br />468-3420 <br />SITE NAME: INSPECTION DATE: <br />SITE ADDRESS:L! CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />NK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE OF INSPE ION I <br />SITE COMPUTER # <br />® <br />OP RAT ONAL TA K <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTS <br />/ .0 u.� <br />Yea <br />43 <br />MAJOR MINOR <br />1 2 <br />44 <br />45 <br />3 4 <br />5 6 <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 120 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 132 <br />33 134 <br />35 136 <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />38 39 <br />47 <br />40 <br />7 <br />_ <br />48 <br />41 <br />42 <br />43 <br />44 <br />45 <br />51 <br />46 <br />47 <br />48 <br />49 <br />50 <br />51 <br />52 <br />53 <br />54 <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. ❑ VIOL. <br />OFFICE I RECEI D BY: <br />rz�f'l? �4/1 <br />1 1 :26- /! I `� I I <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv 5/88 0 m <br />