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1.14GROUND TANK OFFICIAL INSPECTION RI!&T <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 COUNTY # ?j <br />468-3420 <br />SITE NAME: 3 INSPECTION DATE: <br />SITE ADDRESS: CIT /STATE/ZIP 3 <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />FORM A AND/OR B SUBMITTED? <br />TANK �j <br />COMPUT /p� <br />TA <br />COMPUTER <br />K <br />COMPUTER <br />TANK <br />COMPUTER CJ 0 <br />`��� <br />NUMBER L,64& <br />PER 12,000 <br />EX .DATE <br />NUM�Ze4,4,� V <br />PER # l�v <br />XP. DATE <br />U � <br />PER # v <br />EXP. DATE L, <br />NUMBER. <br />PER # J �� <br />EXP. DATE <br />T E OF INSPECTION <br />L! <br />SITE COMPUTER # <br />OPERATIONAL TANK <br />ANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />C� <br />3 /� f <br />19 2 <br />21 22 <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />^•� <br />SAMPLING <br />29 30 <br />f <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />1,35 136 <br />CONDITIONS ABATED <br />/ 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />SO <br />0 <br />Lvj <br />ER, <br />48 <br />50 <br />51 <br />53 <br />55 <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. � VIOL. ❑ <br />OFFICE: <br />INSP,i/, <br />39 <br />42 <br />43 <br />45 <br />47 <br />49 <br />RE <br />52 <br />54 <br />56 <br />THE MARKED <br />I �[ lo I <br />TITLE. S/Z,,-,/* <br />NI IT—'I Whita - Original Yellow - Owner's Coov Pink - File Conv <br />1 4, //A e"- <br />19 <br />S AND MUST BE COR CT AS. <br />RECEIVED BY: I <br />� y\ <br />PHO�V� � 1 1I 2 BECK: <br />bb 5/88 n m <br />