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1 <br />4 <br />!V COUNTY NAME * <br />SI T E NAME: <br />(INSPECTION <br />DATE: <br />7 <br />SRE ADORESS:1T <br />Ess. <br />T, <br />CRY/STATE/ZIP <br />7 <br />CHANGiiA <br />NO <br />TANK TAMC TANK TANK <br />bFR/PE <br />TYPE PI7TER <br />D 030� D•D• D • <br />(EXP: <br />PER A' PER • PER • PER <br />DATE EW DATE EXP: DRE EXP. DRE <br />OPERAMAV. <br />MN. <br />PERMIT 70 OPERATE <br />, <br />2 <br />CH44GENOONOMO1SToOPEWE <br />] <br />4 <br />APPROVED CONSTRucnoN N <br />s <br />e <br />WRRTEN MOWTORNO PROCEDURES A) <br />7 <br />e <br />APPROVEO MOFIRORNG SYSTEM E <br />Y <br />10 <br />M0NrT0 V4 SYSTEM OFER MAL—E <br />11 <br />12 <br />APPROVED MOWOR FREOIENCYN <br />IJ <br />14 <br />MONRORNG RECORDS MWAMJED E <br />15 <br />18 <br />ACCESS CASSECURED N <br />17 <br />18 <br />P1PRKi <br />10 <br />20 <br />NVENMRY RECONCILIATION F <br />21' <br />22 <br />DV/K OAUGM E <br />23 <br />24 <br />APPROVED RESPONSE PLAN N <br />251 <br />26 <br />UNAUYHOFKZE0 RELEASE OCCLSWIENCE <br />27 <br />28 <br />SAMPLING <br />291 <br />APPROVED TANK REPAIRS <br />JI <br />32 <br />LRUIITHDRZEO RELEASES REPORTED <br />JJ <br />34 <br />SAFETY HAZARD <br />35, <br />36 <br />CONORIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />1 1391 <br />FLAMMABLE MPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41- <br />421 <br />POWER DISCONNECTED <br />v <br />OWNER/OPERATOR MONITORING <br />N. <br />451 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46, <br />47 <br />PIPING <br />46 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 1 <br />m <br />UNAUTHORIZED RELEASE <br />111 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER AFSANOONMENT <br />55i <br />56 <br />SYSTEM STATUS (VST MMX 0t EI <br />THE MARKED ITEMS REPRESENT VIOLATIONS /AIOm�.tJ..ST BE CORRECTED AS <br />FOLLOWS <br />O MINOR SB 50 <br />VIOL_VIOL- VOL <br />P96PRUN LOCAL HEALTH OISTRI <br />NSP <br />RECENEDBY: <br />POST OFFICC 13OX 2009 <br />ycyC % <br />STOCKTON. CALIF. 95201 <br />r <br />rjTN: ENVIRON. HEALTH <br />TM -E:( <br />�/ <br />� � <br />RECK <br />mr,., 0- <br />