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U GROUND TANK OFFICIAL INSPECTION R RT 7 �� <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 />SITE NAME: <br />SITE ADDRESS: � <br />I <br />CHANGES SITE/OWNER/PERMIT? Y NO TANK <br />FORM A AND/OR B SUBMITTED? COMPUT <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER <br />OPERATIONAL TANK <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 />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 />SYSTEM STATUS (MUST MARK ONE) <br />PER # <br />® v <br />EXP DATE <br />TANK CONTENTS <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />9 10 <br />11 <br />12 <br />13 <br />14 <br />� _ ._ ..... <br />15 <br />16 <br />17 18 <br />19 20 <br />21 <br />22 <br />23 <br />24 <br />_ _ w _ - , ____._... <br />25 <br />26 <br />27 <br />28 <br />29 <br />30 <br />31 <br />32 <br />w ` ..... ___ <br />.. <br />33 <br />34 <br />35 <br />36 <br />37 <br />__ .. <br />INSPECTION DATE: <br />- <br />CITY/STATE/ZIP <br />TANKRI <br />TANK TANK <br />COMPUTE OMPUT COMPUTE <br />NUMBER UMBER C NUMB <br />PER # PER # ( 1 /w PER # <br />EXP. DATE r% if EXP. DATE EXP. DATE <br />38 39 <br />40 <br />41 42 <br />43 <br />44 45 <br />MAJOR 57 MINOR 58 59 <br />NO <br />VIOL. ❑ VIOL. ❑ VIOL. Lt <br />OFFICE <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED A <br />FOI I OWq- . —` J ,' : f1 <br />RECEIVED BY: <br />ANNIL <br />TITLE: _ PHONE: BECK: <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />a <br />5/88 0n� <br />