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03r <br />COUNTY NAME IF S tJ j <br />SITE NAME: — <br />INSPECTION DATE: <br />SITE ADDRESS: Lv <br />CITY/STATE/ZIP <br />�l S- S <br />?d <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />IANK <br />TANK LINK I TANK <br />MFR/PERMIT SUBMITTED <br />rill <br />ID P <br />0f o• b <br />INSPECTION SITE COMPUTER ♦ <br />PER I <br />PER I PER • PER III <br />EXP. DATE <br />EXP. DATE EXP DATE EXP. DATE <br />OPERATIONAL LANK MAJ. <br />MIN <br />PERMIT TO OPERATE 1 121 <br />CHAt4GE IN CONDMONS TO OPERATE J 141 <br />APPROVED CONSTRUCTION 6 1 <br />8 <br />WRITTEN MONITORING PROCEDURES 7 181 <br />APPROVED MOMTORINO SYSTEM 9 1,01 <br />MONRC)RNO SYSTEM 11 1121 <br />APPROVED MONITOR FREQUENCY 13 1141 <br />MON(TORINO RECORDS MAINTAINED 151 1161 <br />ACCESS CASINO SECURED 17 1,81 <br />PIPING 19 1201 <br />INVENTORY RECONCILIATION 211 1221 <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />I <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29' <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35i <br />36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38, <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41:: <br />14211 <br />POWER DISCONNECTED <br />43 <br />CNu,MER/OPERATOR MONITORING <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 1461 <br />1471 <br />PIPING 46t54 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />SAMPLING 53I.IPROPER <br />ABANDONMENT 55 <br />THE MARK <br />MS PRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST M X ONE) <br />fOLLOJJS: <br />MAJOR 57 MINOR 58 NO �Ifb�eTT <br />VIOL. ❑ VIOL ❑ VIOL. LJ <br />U <br />WIMQUN LOCAL HEALTH DISTRI <br />NSP. <br />RECEIVED BY: <br />POST OFFICE BOX 2009 <br />STOCKTON. CALIF. 95201 <br />PHOK: <br />RECK: <br />,VTN: ENVIRON. HEALTH <br />/ <br />r,I,nr O- <br />