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LISGROUND 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 rfl1INTY # <br />SITE NAME: —77� <br />Lk) C S <br />INSPECTION DATE: <br />SITE ADDRESS: l4 --f F_ L co+�,;-c� CITY/STATE/ZIP F. <br />CHANGES SITE /OWNER/PERMIT? <br />YES <br />NO <br />TANK TANK Z TANK 3—TA—NK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # <br />NUMBER NUMBER NUMBER NUMBER <br />Z3 Z'3S�3 <br />PER # PER # PER # PER # <br />EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />4' <br />Ar <br />PERMIT TO OPERATE <br />1 <br />2 <br />7 <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 />--- -- --------- <br />APPROVED MONITORING SYSTEM <br />10 <br />MONITORING SYSTEM <br />-9 <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />------- <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />-- -------- --- <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY 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 />- — ------ ----- - <br />SAMPLING <br />29 <br />30 <br />------------ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />M43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />m <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />[55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />I I <br />FOLLOWS: r, <br />57 58 <br />59 <br />MAJOR MINNO <br />VIOL. ❑ ❑ <br />❑ <br />UL �pj�a& tmy��_ 1&i_�elr L Lv?zs <br />VIOL.OR <br />VIOL. <br />A <br />OFFICE.- <br />INSP: <br />RE VED BY: <br />TITL: <br />PHONE: <br />BECK: <br />HuT-3 m"ite-ummai Yanow - owner's G0DV Pink - File (r)nv <br />