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Go <br />('nl IIJTV klAi, <br />Omer 0- <br />�....... , ..,,,.,� . <br />SITE NAME:G <br />L <br />INSPECTION DATE: <br />I <br />SITE ADDRESS: <br />V <br />qrl <br />CITY/STATE/ZIP <br />� <br />a rl Po S Zzo <br />CHANGES SITE/OWNER/PERM <br />1 YES <br />TANK TANK TANK <br />MFR/PERMIT SUBMITTED <br />- <br />TYPE OF INSPECTION SITE COMPUTER •PER <br />INOTANK <br />II$nH� <br />3ID0 <br />I PER • IW00c2- PER • 1908'OOQ"$ PEREXP. <br />DATE <br />EXP. DATE El(PDATE EXP. DATE <br />OPERATIONAL TANK <br />MAJ <br />PERMIT TO OPERATE <br />t <br />2 <br />CHA W IN CONDITIONS TO OPERATE <br />9 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />g . <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />- APPROVED MONITORING SYSTEM <br />B <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORINQ RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASMO SECURED <br />17 1181 <br />PIPING <br />19 1201v <br />"N7ORY RECONCILIATION <br />21' <br />22 <br />TANK GAUGINGI <br />231 1241 <br />APPROVED RESPONSE PLAN <br />2526 <br />. <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING <br />29' <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32' <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD <br />35, <br />36 <br />CONOITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />36, <br />39 <br />FLAMMABLE VAPORS REMOVED <br />4O <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />N, 145i <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />461 <br />47 <br />PIPING <br />46 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />511 <br />52 <br />SAMPLING <br />531 <br />54 <br />IMPROPER ABANDONMENT <br />551 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: _ <br />�G T=oy l()Lol 1 4L1Q/, <br />1 <br />57 50 <br />59 <br />MtiIOR MINOR <br />❑ <br />NO <br />E:] <br />NOL VIOL .C]1 <br />VIOL <br />PW6 UN LOCAL HEALTH DISTRI <br />NSP:y—S <br />RECEIVED BY: <br />POST OFFICE ETOX 2009 <br />STOCKTON. CALIF, 95201JVT <br />- -- <br />P1�oNE: <br />BECK <br />N: ENVIRON. HEALTH <br />TITLE:,<�,IhtfGittdLV" <br />Omer 0- <br />