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• COUNTY NAME e J -3� <br /> SITE NAME: I INSPECTION DATE: d <br /> SITE AbORESS: 5 A4 q CITY/ST74TE/ZIP �� <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK <br /> MFR/PEFW SUBMITTED 0. 01' 0• v fD 0 ID O <br /> TYPE OF NSPECTIOpN SITE OOI IPUIER 0 PER 0 PER 0 PER 0 PER• <br /> X? � Y j EXP.DATE EXR OATS EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE S l <br /> APPROVED CONSTRUCTION Is 8 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED L40WTORI G SYSTEM B 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 11 <br /> MONITORM RECORDS MARITANJEO IS 18 <br /> ACCESS CASNG SECURED 17 18 <br /> PIPING 1B 20 <br /> PNENTORY RECONC"nON 21' 22 <br /> TANK GAUGNO 23 21 <br /> APPROVED RESPONSE PLAN 25 28 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 291 30 <br /> APPROVED IANK REPAIRS 31 32 <br /> UNAU 14ORI2ED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 351 38 <br /> CONORKOtS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41! a2 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING N, 4 <br /> 5 <br /> PERMANENT TANK CLOSURE <br /> RE MODAL OF RESIDUAL MATERIALS ae a7 <br /> PIPING 48i /9 . <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 511 52 <br /> SAMPLING 531 54 <br /> IMPROPER ABANDONMENT 551 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS IMUST Mum ONE) FOLLOWS: 2 '' a4l- <br /> 57 58 50 <br /> MA.JOR MIN NO <br /> VIOL. ❑ VIOL ❑ VIOLI�J <br /> 1?969�4I141 LOCAL HEALTH DIST RI( NSP.�j p�J RECEIVED SY: <br /> POST OFFICE BOX 2009 �l �"r^' <br /> STOCKTON. CALIF. 95201 PHONETiTLE.. <br /> N: ENVIRON. HEALTH "� <br /> nnnr O. <br />