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AGROUND TANK OFFICIAL INSPECTION R T <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />4 N S J ' S <br />45 an oaquin treat <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME _ Stockton, <br />CA 68-3420 Q1 0388 COUNTY # 2 <br />SITE NAME: INSPECTION DATE: 7- y <br />SITE ADDRESS: CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORM A AND/OR B SUBMITTED? <br />TYPE OF INSPE TION SITE COMPUTER # <br />) <br />NO <br />TANK q <br />COMPUTER <br />NUMBEFJZ, <br />PER # ® / <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />CONTENTS <br />PIPING 48 49 <br />ACCESS LOCATIONS SEALED 41 42 <br />MAJOR MINOR <br />OWNER/OPERATOR MONITORING 44 45 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 154 <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />57 58 59 <br />MAJOR MINOVIOL. ❑ VIOL..R ❑ VOL. ❑ <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />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 />_... ........ <br />.__.....,... <br />_ _ ..__, 1111 _... <br />�_ ... <br />_ .,......m <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />._. ., .._.��� <br />-------------- <br />_........... <br />.._ ..�... _..__....... <br />_ �.._ <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 />jJ11-1.11 <br />CONDITIONS ABATED <br />37 <br />11 <br />------ <br />_ <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 39 <br />�, <br />-.. <br />�el� F <br />y „ <br />r r <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />FLAMMABLE VAPORS REMOVED 40 <br />_1111 _ . <br />PIPING 48 49 <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED 43 <br />OWNER/OPERATOR MONITORING 44 45 <br />UNAUTHORIZED RELEASE 51 52 <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 53 154 <br />IMPROPER ABANDONMENT 55 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />IYSTEM STATUS (MUST MARK ONE) <br />57 58 59 <br />MAJOR MINOVIOL. ❑ VIOL..R ❑ VOL. ❑ <br />OFFICE L, IINSP: <br />J <br />TITLE: \ _ PHONE: BECK <br />HUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />5/88 0 M <br />