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ORGROUND TANK OFFICIAL INSPECTION SORT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 <br />468-3420 <br />ISITE NAME: <br />INSPECTION DATE: <br />1 SITE ADDRESS: CITY/STATE/ZIP <br />-/ Al A6�_1.e,4,A.J / 3, /®n :_,, I - <br />CHANGES SITE /OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK Zt cP i <br />COMPUTER <br />NUMBER <br />TANK ;doZ_ <br />COMPUTER <br />NUMBER <br />TANK -J;e -0;5 /1ANK_4(0 <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER IOAP� <br />_ <br />TYPE OF INSPECTION <br />COMPUTER SITE COM <br />FLAMMABLE VAPORS REMOVED 50 m <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK 'TANK CONTENTS <br />IMPROPER ABANDONMENT 155 156 <br />H V 7 <br />MAJOR I MINOR <br />R <br />THE MARKED ITEMS REPRESENT VIOLATIONS AVD MUST BE CORRECTED AS <br />FOLLOWS:_ <br />;YSTEM STATUS (MUST MARK ONE) <br />—_— <br />t, <br />MAJOR 57 58 59 MINOR E❑ <br />] ­_ <br />VIOL. VIOL. _ VIOL. H I <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< 14 a2- <br />MONITORING RECORDS MAINTAINED 15 16 <br />......... ------- <br />ACCESS CASING SECURED 17 18 <br />PIPING 19 20 <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 24 <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 <br />.. ....... ... ....... <br />TEMPORARY TANK CLOSURE <br />PIPING 48 49 <br />REMOVAL OF RESIDUAL 38 139 <br />FLAMMABLE VAPORS REMOVED 50 m <br />FLAMMABLE VAPORS REMOVED 40 <br />- <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED M43 <br />SAMPLING 1 53 154 <br />OWNER/OPERATOR MONITORING 44 45 <br />IMPROPER ABANDONMENT 155 156 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />PIPING 48 49 <br />FLAMMABLE VAPORS REMOVED 50 m <br />- <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 1 53 154 <br />IMPROPER ABANDONMENT 155 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AVD MUST BE CORRECTED AS <br />FOLLOWS:_ <br />;YSTEM STATUS (MUST MARK ONE) <br />—_— <br />t, <br />MAJOR 57 58 59 MINOR E❑ <br />] ­_ <br />VIOL. VIOL. _ VIOL. H I <br />OFFICE: INSP: IA- RECE ED <br />- -/ _t, 2 � P V 7 <br />TITLE: ,e. 57 1/5- PHONE - <br />HUT -3 White - Original Yellow - owner's copy Pink - File CoDv <br />BECK: <br />