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I <br /> yCOUNTY NAME # <br /> SITE NAME: <br /> INSPECTION DATE: <br /> ,v <br /> KESS: ti 6121) CITY/STATE/ZIP <br /> Cl-OMES I IER/PE tT? YES NQ; TANK IANK TANK TANK <br /> lPERMtT SUBMn-MD 09 ID ID <br /> ID TYPE OFINSPECTIONtiP R <br /> PERPER� � 0 � <br /> EXP.DATE EXP.MATE EXP.DATE EXP.DATE <br /> 0PtAL TANK MIN. <br /> s <br /> PETW TO OPERATE 1' 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 6 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br />{ MONITORING SYSTEM 11 12 <br /> —- <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> a <br /> MONITORING RECORDS MAINTAINED t117 <br /> 16 <br /> ACCESS CASING SECURED 18PIPING 20 <br /> INVENTORY RECONCILIATION 21' 22 <br /> G TANK GAUGING 23 24 <br /> APPROVED RESP()-NSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 291 1301 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 3d <br /> SAFETY HAZARD 35i 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 381 39 <br /> FLAMMABLE VAPORS REMOVED 40. <br /> ACCESS LOCATIONS SEALED 41! 42' <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44, 45i <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48. 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED MS REPRESENT VIOLATIONS AND MUST BE CORR D AS <br /> SYSTEM STATUS(MUST MARK ONES FOILS YS:57 se '� z <br /> MAJOR ® VI ® NO <br /> O 59 <br /> VI <br />;I RMQUN COCAS HEALTH DISTRIGONS RECEIVED BY. <br /> POST OFFICE: BOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> Ng ENVIRON. HEALTH TM-E&- <br /> *� PHONE: BECK: <br />