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UN AGROUND TANK OFFICIAL INSPECTION RL. ;RT S �� <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES l� �- <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> Mailing Address: P.O.Box 388 <br /> COUNTY NAME Stockton,CA 95201-0388 COUNTY # 32 <br /> 468-3420 <br /> SITE NAME: J INSPECTION DATE: 1�. <br /> k! <br /> SITE ADDRESS: O.7 / 1� 17k, <br /> r� CITY/STATE/ZIP �/ TeAl ��9 <br /> CHANGES SITE/OWNER/PERMIT? Y NO TANKTANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUT �1f COMPUTEI. OMPUT COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER ��C NUMBER �t�OtfumBERr�c NUMBEq/),0 01 ) <br /> PER# p��� PER# PF,OL\ PER#PrLt(� �!l PER# YV,7 C/ <br /> Z EXP.DATE EXP.DATE EXP.DATE EXP-DATE�N <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 V <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 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 /> 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 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <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 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED A <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ..r <br /> MAJOR 57 MINOR 58 NO 59 <br /> low- r <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: IN SNIZ X4, RECEIVED BY: <br /> TITLE✓ If,15 PHONE: BECK: <br /> ., �.._.__ v.�i,. n. .._..,n„,.. riirl• -n...... 5/88 OM <br />