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U1,w:_RGROUND TANK OFFICIAL INSPECTION Rbw,,#AT <br /> SAN JOAOUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMEEHTyAL ebeHEeALThHDIVISION <br /> Floor <br /> Mating Address:P.O.Box 388 <br /> COUNTY NAMEStockton,CA 95201-6388 COUNTY # <br /> SCi 1 L G C 488-3426 c <br /> � � 6 <br /> � -t_G.1�� INSPECTION DATE: <br /> SITE NAME: S, :', <br /> SITE ADDRESS: h�J �' J CITY/STATE/ZIP S74661K�t <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK t TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPEC ION SITE COMPUTER PER PER 0 PER +e PER 0 <br /> 12 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK COWFWS <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSIEM 9 10 -t- <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 {",(1 c&,L rey1 L-)oeek <br /> MONITORING RECORDS MAINTAINED 15 16 �`3 <br /> ACCESS CASING SECURED 17 18 j� <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 REPA19S 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 16 35 36 <br /> CONDITIONS ABATED VZ37 <br /> TEMPORARY TANK CLOSURE <br /> I ter, ,��• z,,'� <br /> 'Fj ..a-e � is e• <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 5 <br /> 6 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUSr MARK ONE) FOLLOWS: Su— - <br /> 57 58 59 <br /> MAJO <br /> MINO <br /> oL. ❑ VIOL..R ❑ VOL.❑ _ <br /> OFFICE: INSP: l RECEIVED BY: <br /> TITLE:S f,. R, H PHONE: BECK: <br /> FIUT-3 While,Original Yellow-Owner's Copy Pink-File Copv <br /> PHS 178 (4196) <br />