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U GROUND TANK OFFICIAL INSPECTION ROR <br />T <br />SAN JOAQ PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. SenJoeqquin Street <br />Meliin Addreas: P.0, Box 388 <br />C016TY NAME StcZkton, CA 96201-0388 <br />488-3420 COUNTY #'SITE NAME: <br />INSPECTION DATE: <br />s <br />- <br />SITE <br />•1r` P <br />remiurem-Wila Mel =. * <br />i z <br />ANI <br />lag 14 <br />COMPUTEii <br />#'—TAN <br />77 <br />COMPUTER, <br />com <br />•SITE • <br />EXR DATE <br />EXP. DATE <br />EXF1. DATE. <br />II III <br />OPERATIONAL <br />. <br />I y <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING <br />MONITORING <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDSr <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />APPROVED RESPONSE <br />UNAUTHORIZEDOCCURRENCE <br />SAMPLING <br />m <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />a a E W, 01/1" <br />A • • A r. <br />. • r • r /SOEM <br />114NK ° <br />COMPUTER <br />NUMBFR " <br />FIER # ' <br />E.XII. DALE <br />EMO Or RE ATERIALS6 47 <br />PIPING 48 49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 _ <br />IMPROPER ABANDONMENT 55 156 _ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MJ5,1 I ii C r 1l'I li (,; l I [) Ari <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS:'__ <br />57 <br />MAJOR MING 58 ® 59 <br />NO <br />VIOL. ❑ VIOL. VIOL. <br />OFFICE: INSP: r`- RECEIVED BY: <br />TITLE: PHONE: RFCI{ <br />3 <br />HUT -3 White - Ori®inel Yellow -Owner's Copy Pink • File Copy ^ <br />