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40 COUNTY NAME • `, -Sf <br /> SITE NAME: /S �j�1 ULA INSPECTION DATE: <br /> SITE ADDRESS: �l . �� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES N9 ' TANK TANK <br /> TANK TANK <br /> MFR/PERMIT SUBMITTED ID• �'/ ID O D• D• <br /> TY OF INSPECTION SITE COMPUTER♦ PER• PER• PER• PER/ <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 6 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21' 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35, 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38, 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41! 42' <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144, 1451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48 491 . <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 <br /> IMPROPER ABANDONMENT 55 58 <br /> THE MARKED ITEMS REPRESENT VXXATIONS MID MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS K <br /> INOR NO NOL. ❑ MVIOL LJ VIOL❑ J a <br /> -?U 1Q IN LOCAL HEALTH DISTRI NS RECEIVE BY. <br /> POST OFFICE E30X 2009 <br /> STOCKTON. CALIF. 95201 E: BECK: <br /> N: ENVIRON. HEALTH TTEyn <br /> „ e, o- <br />