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COUNTY NAME ♦ j <br /> SITE NAME: /� , <br /> 1W' <br /> _SNI U/✓7 <br /> + ' ! 7-1 ` Fi INSPECTION DATE: <br /> SITE ADDRESS: V sG'{�GIYG�.�Q� CITY/STATF,J f✓ �� �-�u// <br /> h G}iMgES SITE/ONMER/PERMIT? S NO TANK TANK J K TANK <br /> SUBMITTED <br /> TYPE OF V SPEC"ON 1D ID• ID• D• <br /> SITE ODMPIlIER, •/ PER PER• <br /> ` <br /> / � PER• PER• <br /> '7 EXP.DATE EXP.DATE ExP.DATE EXP.GATE <br /> OPERATIONAL TANK MAJ MIN. <br /> PERMIT 10 OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE s a <br /> APPROVED CONSTRUCTION 6 e <br /> WRITTEN MONRORINO PROCEDURES 7 e <br /> APPROVED MONRORWG SYSTEM B 10 <br /> MOWTORM SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONr0RINO RECORDS MAINTAINED 15 19 <br /> 0 ACCESS CASINO SECURED 17 18 <br /> PIPINO 79 - 20 <br /> INVENTORY RECONCIUATION 21' 22 <br /> TAM( GAUGING <br /> 231 24 <br /> AP'PROVFI O RESPONSE PIANI 25 26 .. <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 <br /> SAMPLING 291 301 1 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 351 36 <br /> CONDITIONS ABATED mi37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36, 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 411� 42 <br /> POWER DISCONNECTED Q <br /> OWNER/OPERATOR MONITORING 44, 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 4649 - <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 5152 <br /> SAMPLING 531 54 <br /> IMPROPER ABANDONMENT 561 56 <br /> THE MARKED ITEMS REPRE NT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE FOLLOWS. -r <br /> 59 <br /> V� a� a VNVOL <br /> S R56QUN LOCAL HEALTH DISTRI NSP. RECEIVED BY: <br /> POST OFFICE BOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> AJ-TN: ENVIRON. HEALTH TITLE: �S PHONE wr <br /> vnio O• <br />