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COUNTY NAME • <br /> SITE NAME: 1 ( if �Q INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> "MES SITE/OWNK SITE/OWNER/PERMIT? YES TATANK TAN( TANK <br /> MFR/PERMff SUBMITTED ID• ID• o# _' p i <br /> TYPE OF INSPECTION SITE COMPUTER• PER• PER• PER• <br /> PER• <br /> Z G'( l EM DATE EXP.DATE EXP.DATE EXP.DRE <br /> OPERATIONAL TANK MAt. MIN <br /> PERMIT TO OPERATE 1' ' 2 <br /> CHANGE N CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION N 5 al I <br /> WRITTEN MONITORING PROCEDURES N 7 a <br /> APPROVED MONITORING SYSTEM F 9 10 <br /> MONITORING SYSTEM OPEICAriCmAE 11 12 <br /> APPROVED MONITOR FREQUENCY N 13 14 <br /> MONITORING RECORDS MAINTAINED E IS 16 <br /> n <br /> ACCESSCASING SECURED At 17 16 <br /> r% PIPING 4'1�.`V/y%zc 16 20 <br /> INVENTORY RECONCILIATION E 21' 22 <br /> TANK GAUGING E 2J 24 �-' <br /> APPROVED RESPONSE PLANK 25 1261, <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 JB 39 <br /> FLAMMABLE VAPORS REMOVED b MINIM I Al <br /> ACCESS LOCATIONS SEALED 41! L <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING u 45i I <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 1461 1471 <br /> PIPING 46 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 5a <br /> THE MARKED ITEMS REPRESENT VIOU1TIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS. <br /> Su iz ' <br /> MAJOR �-5-i7MINOR 59 NO 59 L 2 <br /> VIOL El VIOL. El VO ❑ <br /> AV <br /> f <br /> I tk4l If=12, Z A <br /> P116AMN LOCAL HEALTH DISTRI NSP: RECEIVED BY: <br /> POST OFFICC E30X 2009 4AW 1�7� <br /> STOCKTON. CALIF. 85201 Ave- <br /> N: ENVIRON. HEALTH TITLE: *uT# ,�1q� _� "� C <br />