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ARGROUND <br />TANK OFFICIAL INSPECTION <br />&RT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />38 139 <br />40 <br />41 42 <br />M43 <br />445 N. San Joaquin Street <br />COUNTY NAME <br />44 45 <br />Mailing Address: P.O. Box 388 <br />Stockton, CA 95201-0388 <br />COUNTY # <br />468-3420 <br />,SITE NAME: <br />INSPECTION DATE: <br />SITE ADDRESS: <br />CITY/STATE/ZIP ®�!/ <br />CHANGES SITE /OWNEK/ PERMIT? YE 9 <br />NO <br />TANKe TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />_:5 <br />COMPUTER COMPUTER <br />COMPUTER COMPUTER <br />TYPE OF INSPECT ON SITE COMPUTER # <br />NUMBER �IP40 NUMBER <br />:y1 <br />�'A6RArl- <br />NUMBER NUMBER <br />PER # PER # <br />PER # PER # <br />45- <br />EXP. DATE EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />'TANK <br />CONTENTS <br />0' <br />MAJOR <br />MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />.. .... <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />/-3 <br />-7 W/ . <br />..... - -- ------ - --- ----- --------- <br />--- <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />iEMOVAL OF RESIDUAL MATERIALS <br />11PING <br />1AMMABLE VAPORS REMOVED <br />JNAUTHORIZED RELEASE <br />'AMPLING <br />MPROPER ABANDONMENT <br />(STEM STATUS (MUST MARK ONE) <br />�Im <br />E. <br />ON <br />MAJOR 57 M58 ­� 59 <br />VIOL. El VIOL" L-1 VIOL. LJ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS - <br />OFFICE: INSP: REC ED BY: <br />�A <br />TITLE: <br />P E- BECK: <br />HUT -3 White -Original Yellow - Owner's copy Pink - File Copv 5/88 0 m <br />38 139 <br />40 <br />41 42 <br />M43 <br />44 45 <br />�Im <br />E. <br />ON <br />MAJOR 57 M58 ­� 59 <br />VIOL. El VIOL" L-1 VIOL. LJ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS - <br />OFFICE: INSP: REC ED BY: <br />�A <br />TITLE: <br />P E- BECK: <br />HUT -3 White -Original Yellow - Owner's copy Pink - File Copv 5/88 0 m <br />