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COUNTY NAME • 3 c <br /> INSPECTION DATE: <br /> SITE NAME: P <br /> SITE ADDRESS: 7 q CITY/STATE/ZIP r c-�c <br /> CHANGES SITE/OWNER/PERMIT7 YES NO TANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED o/ jS(oV uoo o IF 15c�y 1 0• o• <br /> TYPE OF NSPECTION SITE COMPUTER• PER# 5z c, �' PER• w c� PER PER• <br /> I fln.l� 1VLrnwi�X `-� (� EXP DATE Di eS�_/ EXP DAM IL c� - Elm DATE EXP.DATE <br /> OpEpAnoNAL TANK m" MIK <br /> PERMIT To OPERATE 1 2 <br /> Cf WKIE N COfMM NQS TO OPERATE 1 141 121S! <br /> APPROVED CONSTRUCTM a <br /> WRRTFN MONTORNO PROCEDURES a <br /> -APPROVED MONITORING SYSTEM 10 <br /> MQNIIORNG SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONnTRNG RECORDS MARMINED to _ <br /> ACCESS CASNG SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 24 <br /> APPROVED RESP f ISE PLAN 2aUNAUTHORIZED RELEASE OCCURRENCE 2BSAMPLING 30APPROVED TANK REPAIRS 32LNAUTTIORIZED RELEASES REPORTED 3aSAFETY HAZARD 36CDN OCTIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36, 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED a 1! 42 <br /> POWER DISCONNECTED 43 t <br /> OWNER/OPERATOR MOMTDRINIO N 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS MA3 <br /> PIPvK,FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE SAMPLING IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(AA/ST MARK ONE) FOLLOWS: <br /> ks r -n — Thar l <br /> s7 58 s9 <br /> MAJOR WNOR NO j <br /> V"- VIOL_ ❑ VIOL❑ <br /> Sep ockcveD ce <br /> ' R56K*IN LOCAL IIEALTH DISTRI NSP. RECEIVED BY: <br /> POST OFFICE BOX 2009 ' <br /> STOCKTONT. CALIF. 95201 PHONE <br /> N: ENVIRON. HEALTH WOK <br />