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t <br /> SrM NAME COUNTY NAME dr <br /> WE ADDRESSINSPECTION DATE 4_1I a <br /> C ry/STArt /vaa—rte <br /> ay�.1 1-�ot_.�.v blz tv E �,- q5:376 <br /> CHANGES SITE/C IrNER/PERMIT? YES NO TANK RtcrZ R TANK ON4LHA9 TANK TANK <br /> MFR/PEAMTT SUBMITTED <br /> TYPE OF 1NSF'ECT]ON SITE COMPUTER f 10 ! p O a ID f p r <br /> EXP.DATE PER Ejlp it <br /> PEft i PER ♦ � <br /> EXP GATE EXP DATE <br /> OPERATIONAL 'MNK MA.J. MIN. <br /> PERMIT TO OPERATE 1 z <br /> CHA"GE N CONDITIONS TU OPERATE a 4 <br /> APPPOVEO RUCTION 5 8 <br /> WRITTEN MONCOR*4G PROCEDURES 7 g <br /> APPR011ED I.IOtdfT )RING SYSTEM 9 10 <br /> M0NnX)RM SYSTEM 11 12 <br /> APPRpVED MONITOR FREOLENCY 13 14 <br /> M(> TOR*4 RECORDS MAlNTA*EO 15 18 <br /> ACCE3S CA,SM SECURED 17 18 <br /> PIPINCI 19 20 <br />"1 ENTORY RECONCUAT)ON 21; 22 <br /> TAMC > K3 23 24 <br /> APPRCWED RESPnNSE PLAN n27 <br /> 21B <br /> UNAUTlr4 RfZED RELEASE OCCURRENCE 28 <br /> SAMPLING 29` 30 <br /> TANK REPAJRS 31 32 <br /> ZED RELEASES REPORTED 33 �4 <br /> SAFETY HAZARD 35, <br /> 361 <br /> CONORIONS ABATED 3T <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIOUAL 38, 39 <br />-L,WMA&Z VAPORS REMOVED 4p <br /> ACCESSLOCAnCNS SEALED 41. 42 <br />'aVER DSCONNECTED 43 <br /> DWNER/OPERATOR MON T JNG 4s, 451 <br /> PERMANENT TANK CLOSURE <br /> 1EMOVAL OF RES;OUAL MATERIALS 461 47 <br /> 1 1 —011111111 <br />(PING 48 49 <br /> LAMMA13LE VAPORS REMOVED w <br /> WAUTHORIZED RELEASE 51 52 <br /> AMPUNG 53 54 <br /> APPOPER A8ANDONMENT 55 56 <br /> THE MARKED rfEMS REPRESENT VK)LATIONS ANO MUST BE CORRECTED AS <br />^STEM STATUS I-u T r,U4gK pr.+E1 ��77 <br /> FOILOvV^ o`+ <br /> 57 5S <br /> ❑ a NO <br /> VlOt- <br /> iMPN LOCAL IIEALTH DISTRI t4SP- sEy Fpm. RECEIVED BY <br />'OST OFrICC 13OX 2009 <br />'OCKTON CALIF 95201 <br /> TN: ENVIRON. HEALTH TM-E SA-N1Ve1. PHONE PECK <br />