COMPLIANCE INFO_1993-1998 - Laserfiche WebLink

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OERGROUND TANK OFFICIAL INSPECTION ORT SAN JOAQUIN PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N. San Joaquin Street Mailing Address: P.O. Box 388 COUNTY NAMEStockton, CA 95201-0388 COUNTY # 468-3420 SITE NAME: INSPECTION DATE: &�ieup_ot4 SITE ADDRESS: CITY/STATE/ZIP &ilimp o, .117 CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK - COMPUTE7 COMPUTER FORM A AND/CIR B SUBMITTED? NUMBER /COMPUT MPUTE t, COMPUTER # up NUMBER UMBER TY OF INSPECTION 1A � 0 �U V NUMBER PER #/ PER # PER 4,20 PER # Xot4f 7P&i-11 DATE EXP. D EXP DATE EXP. 6;j EXP. DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 -- --- ---------- ----- - -------- PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 .... . .... ..... . SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 136 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 139 FLAMMABLE VAPORS REMOVED 40 m ACCESS LOCATIONS SEALED 41 42 — ------- --- --- - -- -- POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 153 54 IMPROPER ABANDONMENT 155 156 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS (MUST MARK ONE) FOLLQWS:_ MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOLIN OFFICE: INS Em I PHONE -/ .1--"'— TITLE: )/< BECK: Y-1 ? __.5e I HUT -3 White -Original Yellow - Owner's Copy Pink - File Copv 5/88