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LHUT -3 White - Original Yellow - Owner's Copy Pink - File Copv <br />COUNTY NAME <br />SITE NAME: <br />U&GROUND TANK 'OFFICIAL INSPECTION ART <br />SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N. San Joaquin Street <br />Mailing Address: P.O. Box 388 <br />Stockton, CA 95201-0388 <br />468-3420 <br />INSPECTION DATE: <br />SITE ADDRESS:—� <br />&CITSTATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPO ER <br />NUMBEV 0 <br />COMPUTER <br />NUMBEj?,000 <br />=U <br />NUMBE 6 <br />ER <br />R <br />7 <br />OMPUT 0 <br />LMEZ- <br />TYPE INSPECTION <br />SITE COMPUTER # <br />PER # <br />PER # <br />PER I"'PEFj <br />fA:W <br />7 <br />EXP. DATE <br />EXP. DA <br />11, XP. E <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <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 />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16_ <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20_ <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />. .... . <br />TANK GAUGING <br />23 <br />124 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />136 <br />CONDITIONS ABATED <br />P7_ <br />- <br />37 <br />-- <br />---- <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 />43::j <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />147 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />MI <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 />FOLLOWS: <br />57 58 <br />59 <br />- lqef-3 <br />--j11- <br />�XpvPP'r-Y <br />M <br />MAJOR MINOR <br />El L❑J 'v'16L. <br />VIOL. v I <br />A <br />OFFICE: <br />INS -4 <br />RECEIVED BY: <br />Nl� <br />TITLE: <br />PHON <br />ECK: <br />5/88 0 m <br />