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U1rs�ERGROUND TANK OFFICIAL INSPECTION R6,0,,AT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMEENT\AL HEAber Ave.,LTH DIVISION <br /> 304 E.Mailing Address:P.O.Box 388 <br /> COUNTY NAME <br /> Stockton,468-39420520 <br /> 3952 1-0388 COUNTY # <br /> . SITE NAME: Ar_ J e INSPECTION DATE: <br /> SITE ADDRESSS: .� ,^ CITY/STATE/ZIP �' .,. �`� <br /> 7 ✓�i Z4 ...�✓OPV <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK vf( TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER PER PER # PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENB .[� <br /> OPERATIONAL TANK MAJOR ---- <br /> PERMIT TO OPERATE I 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 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> ,NVENTORY 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 REPORIED 33 34 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE V <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 4142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVA AL MATERIALS 46 47 <br /> PIPING A91 48 49 <br /> FLAMMAB 4OVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUSF MARK ONE) FOLLOWS:. - r` = --- -- --- <br /> 57 58 59 <br /> VIOL R ❑ _.__VIOL.NOR ❑ NQ <br /> VOL.❑ -- <br /> OFFICE: INSP ,,,, ,,iG J RECEIVED BY: <br /> TITLE: 0 4 7 PHONE: BECK: <br /> 1-IUT-3 While.Original Yellow-Owner's Copy Pink•File Copv <br /> PHS 178 (4/96) <br />