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AGROUND TANK OFFICIAL INSPECTION RE& <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E bar Ave., Third Floor <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 COUNTY# <br />468-3420 <br />SITE NAME: AlrN% INSPECTION DATE: <br />SITE ADDRESS:NA CITY/STATE/ZIP _S <br />7—f—L", 4A?lj <br />CHANGES SITE /OWNER/PERMIT? YES <br />FORM A AND/OR B SUBMITTED? <br />TY ON SITE COMPUTER # <br />TYPE <br />e <br />Z-6 <br />elqD-) TANK <br />COMPUTER <br />NUMBER <br />PER # /0/ 00 <br />EXP. DATE <br />TANK 21 <br />COMPUTER <br />NUMBER <br />PER # 101 0 -0 <br />EXP. DATEy <br />TANK <br />COMPUTER <br />NUMBS Fk <br />PER , <br />EXP. DATE <br />-TANK <br />COMPUTE� <br />NUMBER <br />CA a6v <br />PER # Ili <br />EXP. DATE <br />OPERATIONAL TANK <br />TAM CONTENTS <br />a <br />46 <br />47 <br />Miki6fi <br />iANOR <br />48 <br />49 <br />PERMIT TO OPERATE 1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <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 />!NVENTORY RECONCILIATION <br />21_ <br />22 <br />TANK GAUGING <br />23 <br />24 <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 I IAZARD <br />35 <br />136 <br />1 <br />CONDITIONS ABATED <br />37 §M <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />-g4ff& ol;lllmt <br />AEMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORREG I EU AS <br />(STEM STATUS (MUSr MARK ONE) FOLLOWS - <br />57 58 59 <br />MAJOR [j MINOR NO r�-� <br />VIOL. VIOL. VIOL. [!!I <br />OFFICE: INSP: RECEIVED BY: <br />TITLE: PHONE:— <br />HUT-3 White -original yellow - Owner's Copy Pink - File Copv <br />m <br />BECK: <br />PHS 178 (4/96) <br />P4 7? 6 <br />"A <br />46 <br />47 <br />48 <br />49 <br />50 <br />mm <br />51 <br />5 <br />53 <br />54 <br />156 <br />1 <br />55 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORREG I EU AS <br />(STEM STATUS (MUSr MARK ONE) FOLLOWS - <br />57 58 59 <br />MAJOR [j MINOR NO r�-� <br />VIOL. VIOL. VIOL. [!!I <br />OFFICE: INSP: RECEIVED BY: <br />TITLE: PHONE:— <br />HUT-3 White -original yellow - Owner's Copy Pink - File Copv <br />m <br />BECK: <br />PHS 178 (4/96) <br />