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I <br /> COUNTY NAME <br />;SITE NAME: <br /> k,HA� ��� /-/o U,e INSPECTION DATE: <br /> SITE ADDRESS: STATE/ZIP,;g2p <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK Z TANK TANK <br /> MFR/PERMIT SUBMITTED ID# ID• ID# ID F <br /> TYPE OF INSPECTION SITE COMPUTER♦ PER# PER ♦ PER# PER <br /> 10i�S9 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONOMNS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> 1 MONITORING SYSTEM 1112 <br /> APPROVED MONITOR FREQUENCY 131 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> j_ <br /> INVENTORY RECONCILIATION 21' I2JX <br /> TANK GAUGING 231 24 <br /> APPROVED RESPgNSE PLAN 251 261 1 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29' 30 <br /> APPROVED TANK REPAIRS 31 3211 <br /> i <br /> UNAUTHORIZED RELEASES REPORTED 33 34' <br /> SAFETY HAZARD 351 36 <br /> CONDITIONS ABATED 37 VA <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 44 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46! 47 <br /> PIPING 48i 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 j 52 <br /> SAMPLING 531 554 <br /> IMPROPER ABANDONMENT 1551 1561 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) /-J CJJ 70 <br /> K� T S7 iid site ,�-vz ��/��✓ <br /> MAJOR 57 MINOR ((58 NO 59 r �Q <br /> VIOL_ ❑ VIOL 1J, VKX ❑ <br /> S FMQUN LOCAL HEALTH DISTRI NSP: ,,�„��-�' RECEIVED BY: <br /> POST OFrICFr LI0X 2009 ,�,�/l1LDOo� ",� ND✓�/ (!aS J yR2vd 7 <br /> '' Li ASL i:�:' G" S7,eA <br /> S_TOCKTON. CALIF. 95201 TITLE. R PHONE RECK <br /> N: ENVIRON. HEALTH <br />