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` <br /> U$RGROUND TANK OFFICIAL INSPECTION ART <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 446 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME pct. Stockton,CA 96201.0388 <br /> 468-3420 COUNTY 1 <br /> SITE NAME: t t t,CK �- /® 7LP INSPECTION DATE: <br /> SITE ADDRESS: 03 0 S, 0 /1' CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION ISItE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> .7 PER# PER# PER# PER# <br /> LF 0 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> ATIO AL TANK rnH�ccorTE <br /> rrrs I <br /> MAJOR MINOR , m 7 <br /> r <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 /> .. ....,.,.. ____ _.-___ <br /> APPROVED RESPONSE PLAN 25 26 <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 /> TEMPORARY TANK CLOSUREON <br /> � � < <br /> t <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 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 CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FQLLOWS: <br /> .�i <br /> MAJOR 57 MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP:ee-0RECEIVED BY: , <br /> TITLE: ldr< PHONE: K: <br /> HUT-3 White-Orninal Yellow-Owner's CooN Pink-File Coov u <br />