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USGROUND TANK OFFICIAL INSPECTION RII&IT <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1*m"*emW*mq"WAm" <br />Mailing Address: P.O. Box 388 <br />COUNTY NAME Stockton, CA 95201-0388 <br />468-3420 COUNTY # <br />SITE NAME:INSPECTION DATE: <br />-7-fih4n- ajA A.,fd .2 A lel, <br />SITE ADDRESS- CITY/STATE/ZIP <br />CHANGES SIT ER/PERMIT? YES W TANK TANK TANK- ---TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br />PER # PER # PER # PER # <br />EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK 'TANK CONTENTS <br />MAJOR _IN R <br />PERMIT TO OPERATE 1 2 <br />CHANGE IN CONDITIONS TO OPERATE 3 4 <br />APPROVED CONSTRUCTION 5 6W <br />WRITTEN MONITORING PROCEDURES 7 8 <br />APPROVED MONITORING SYSTEM 9 10 <br />MONITORING SYSTEM 11 14!F <br />APPROVED MONITOR FREQUENCY 13 44 <br />MONITORING RECORDS MAINTAINED 15 16 <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 ---f36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE <br />R, <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 />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 />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />153 <br />54 <br />IMPROPER ABANDONMENT <br />155 <br />156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:- ±Eagg Am - <br />57 58 <br />59 <br />MAJOR ❑MINOR NO <br />VIOL, VIOL.❑ VIOL. <br />TITLE: BECK: <br />HUT®3 White - Or"ainal Yellow - Owner's CODV Pink - Fila Cnnv <br />