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it s <br />(U0UNI Y NAML / 37 <br />INSPECTION DATE: � <br />ITE NAME: t"/^Z <br />IrTE ADDRESS: 2 <br />l<AYS'd , 7Z13) <br />C"/STATE/ZIP <br />C C qS3 <br />*W4GES &TE/01WNER/PERMT7 <br />YES <br />NO TANK <br />51 <br />LANK TANK <br />TANK <br />FWPERMTT SUBMITTED <br />55 <br />of <br />D• 00 <br />IE)(P.WE lEXP.D09E <br />of <br />YPE OF NSPECTION <br />SITE <br />PER I <br />PER I PER I <br />PER 0 <br />/(.^ .36 <br />EXRORE <br />EXP.DATE <br />DPERIQIONAL TANK <br />MAL <br />MIN <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHMNOE N CDNDITONS TO OPERRE <br />! <br />APPROVED CONSTIM1CT1ON <br />6 <br />6 <br />VVFMEN MONTORIND PROCEDURES <br />7 <br />6 <br />APPROVED MOMTOFOO SYSTEM <br />91 <br />101 11 <br />MOKIORM SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREOUENCY <br />13 <br />14 <br />MONITORM RECORDS LAW WNED <br />15 <br />16 <br />ACCESS CASH SECURED <br />17 <br />16 <br />Ppm <br />Ip <br />20 <br />NVENTORY RECONCIUATM <br />21 <br />22 <br />TAMC ONKM W <br />23 <br />24 <br />APPROVED RESPONSE PINI <br />25 <br />26 <br />UNAUTNORYZEo RELEASE OCCURRENCE <br />27 <br />26 <br />SAMPLM <br />29' <br />30 <br />APPROVED TAMC REPAIRS <br />31 <br />32 <br />UNAUTNOR:ZEo RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35; <br />36 <br />CONDMONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RES"J'kk <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OVrtJER/OPERATOR MONRORMJC <br />PERMANENT TANK CLOSURE <br />0=91 <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />PIPING <br />48 <br />FL.AAUAABLE VAPORS REMOVED <br />SO <br />UNAUTHORIZED RELEASE <br />51 <br />SAMPLING <br />53 <br />IMPROPER ABANDONMENT <br />55 <br />SYSTEM STATUS (MUST MARK (k41 <br />57 56 <br />veil ❑ VOL 11NOL-F <br />60 <br />NO <br />a] <br />V <br />m <br />M <br />R66QUN LOCAL HEALTH DISIKI t4-*' <br />POST OFFICC BOX 2009 <br />_ <br />TOCKTON. CALIF. 95201 TME. �5 <br />A,TTN: ENVIRON. HEALTH <br />THE MARKED <br />it�. <br />13E <br />AS <br />rnrnr O- <br />M <br />