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COUNTY NAME w <br /> WE NAME: <br /> INSPECTION DATE: f <br /> SITE ADoRESS: <br /> a44al NDL.1ry DF iv o CrrY/STATE/ZIP �` i <br /> CHANGES SITE/OWNER/PERWT? YES NO TANK T 4G c t r. �I S 3-r Cc <br /> MFR/PERM(T SUBMITTED K��u+.�R TANK UNLn7PER <br /> TANK TANK <br /> TYPE OF,N9PECT1�, SfTE COMPUTER. lof b I PER R 0 aID 0 ID. <br /> TA�v fS V EXP.DATE R PER• <br /> EXP.DATEP.DATE EXP.DATE <br /> OPERATIONAL Ui1NK MAJ. MIN. <br /> PERW T TO OPERATE 1 <br /> 2 <br /> OWWKIE IN OONOMONS TO OPERATE 3 4 <br /> APPROVED OONSTRUICTION 6 e <br /> VVR MN MONM)R M PROCEDURES 7 9 <br /> APPROVED MONRpRING SYSTEM 9T14 <br /> MON11DRM SYSTEM 11 <br /> APPROVED MOWTOR FREOUENCy 13 <br /> MONITORING RECORDS MAINTAINED 15 18 <br /> f ACCESS CASING SECURED rr is <br /> PIPING ita <br /> MW20 <br /> ENTORY RECONCILIATION 2, 22 <br /> TANK GAUGM 23 24 <br /> APPROVED RESPONSE PLAN 25 28 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 21 <br /> SAMPLING <br /> 29 301 <br /> APPROVED TANK REPAIRS IE <br /> 32 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 35F 36 <br /> CONOITIONS ABATED __37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL.OF RESIDUAL 36 39 <br /> FLAMMABLE VAPORS REMOVED ;4(0�)ACCESS LOCATIONS SEALED 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING u 45 a <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46t 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT .551 156 <br /> THE MARKED ITEMS REPRESENT V,OLATIONS <br /> AND MUST BE CORRECTED A5 <br /> SYSTEM STATUS(MUST MARK ONEI +7 <br /> FOLLOWS:__o`er ,G <br /> MAJOR 57 MINOR se w <br /> V,OL„ „IOC <br /> WgOAQMN LOCAL HEALTH DISTRI NSP. Se-/ FoLey RECEIVED 8Y: <br /> POST OFFICC. BOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> N: ENVIRON. HEALTH TM-E: 6Af4ITA-Rrk�4 PHONE: BECK: <br />