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ERGROUND TANK OFFICIAL INSPECTION WRT <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEAL,a DIVISION <br /> 304 E.Weber Ave.. Floor <br /> Mailing Address:P.O.Boat 388 <br /> COUNTY NAME StocktonC A9SWI-0388 20 COUNTY # <br /> SITE NAME: 1 a i INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> Cts 9s33v <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR 8 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER' <br /> /�-� <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> PER 0 1 q� V s U CPER /i*1!l PER 0(0,CCjo PER 0 SW <br /> EXP.DATE EXP.EXP.DATE' EXP.DATE `� EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS r <br /> 12. <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 MONIToniNG SYS IEM 9 IU <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> :'JVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING ` 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIIJS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD a 135 136 <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 m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL.MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORR CTED AS <br /> SYSTEM STATUS(MUST MARK ONE) OLLOWS: -i�`t .. _± <br /> �--r / <br /> MAJOR 57 MINOR 58 I`IO 59 <br /> M .- <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ i <br /> OFFICE: INSP:' . �� C.�` RECEIVED BY: <br /> TITEE) ; rs, ( /A PHONE: HECK: <br /> HUT-3 While•Original Yellow-Owner's COPY Pink-"e COpv <br /> PHS 178 (4l96) <br />