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ERGROUND TANK OFFICIAL INSPECTION ORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> say N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton.C 9520 -0388 1COUNTY # <br /> SITE NAME: ` INSPECTION DATEj4r�( <br /> i <br /> SITE ADDRESS: �.c7u (SCS U� CITY/STATE/ZIPLo_,v c g <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK f TANK TANKTANK <br /> FORM A AND/OR 6 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER I <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# I <br /> _ `/ PER* t0)CG_;v PER # F},OCC PER# 40 0CUD PER # SGC <br /> C /�`� �T11 <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATETAM COWMNTS <br /> I <br /> OPERATIONAL TANK <br /> MAJOR Rfi <br /> PERMIT TO OPERATE ctc,7 1 2 uw­ <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> ._ <br /> * WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 1 L.`J G.SG` 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 /> h APPROVED RESPONSE PLAN 25 26 _ _ _ _✓_... _ .._._ _a_.I� <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> AAJT <br /> TEMPORARY TANK CLOSURE `R <br /> 04— <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 4574 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED J55 <br /> UNAUTHORIZED RELEASE 52SAMPLING 54IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJ59 <br /> VIO OR ❑ MOO57 R ❑ OL 58 NO ❑ <br /> OFFICE: INSP: `t,.� RECEIVED BY: <br /> TIT ^'� C PHONE. BECK: <br /> U1 1T '! W%4. MAS in f Voll`.... 11-1.rte,..... a•�,.I'Cf_r__ v - . <br />