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-pCo l� <br /> . ' 1 . • COUNTY NAME <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: CRY/STATE/ZIP <br /> SES SMOWNER/ YES NO I WK LANK TANG TANK <br /> MFR/PERMIT SLg3kW D ,�. l ID, ID+ ID I <br /> TYPE OF N3PECr m SITE COMPUTER 0 PER I PER• PER• PER• <br /> EXP.DATE EXP.DARE EXP.WE EXP.DATE <br /> OPEPA71ONALIANK MAJ. MMI. <br /> P'ERM[T M OPERATE 1 2 <br /> Cf1ANGE IN OONDITIOW TO OPERATE 3 41 1 <br /> APPPAww ooN$Tii cnm N 6 a <br /> WRIT'1EN MONITORNG PROCEDURESAI 7 a <br /> APPROVED MONITORING SYSTEM E 9 10 <br /> MOMORING SYSTEM OPEWOMAL--E 11 112 <br /> APPROVED MONITOR FREQUENCY N 13 11411 <br /> MONITORING RECORDS MA*(%R4EO E 15 18 <br /> ACCESS CASIh1(i SECURED N 1 T 16 <br /> PIPING+ 19 20 <br /> 104VENTORY RECONCMTM E 21 22 <br /> 1AW GAUGM E 23 24 <br /> APPROVED RESPONSE PLAN N 25 26 <br /> UNALITHORIZED RELEASE OCCURRENCE E35 <br /> 26 <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 36 <br /> CONDMONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36 39 <br /> FLAMMABLE%ODORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41: 42 <br /> POWER DISCONNECTED 43 <br /> ONTJER/OPERATOR MONITORING 44, 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 i 4T <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55' 58 <br /> THE MARKED fTEMS REPRESENT VIOLATIONS AND MUST SE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE FOLLOWS:se 59 <br /> �4� 5�lI✓ _ <br /> MAJOR 57 MINOR NO <br /> VIOL, ❑ VIOL_ ❑ VIOL <br /> S WRUN LOCAL HEALTH DISTRI NSA: RECEIVE BY: <br /> POST OFFICE SOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> N: ENVIRON. HEALTH TITLE46. <br /> ntrner O� <br />