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COUNTY NAME <br /> SITE NAME: / / I /f INSPECTION DATE: l r <br /> SITE AbORESS: CITY/SAE/zlP 7fF, 5x44r <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED ID 0 1ID• ID• 10• <br /> TYPE OF INSPECTION SITE COMPUTER• PER 0 PER• PER• PER• <br /> I EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAV. MIN <br /> PERMIT TO OPERATE 1- 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 t <br /> APPROVED CONSTRUCTION N 5 8 <br /> WRITTEN MONITORING PROCEDURES N 7 B <br /> APPROVED MONITORING SYSTEM U` , 1 9 10 <br /> MONITORm SYSTEM OPE�T10/.NAI�E 1 12 C) - <br /> APPROVED MONITOR FREOUENCY�4 13 14 <br /> MONITORING RECORDS MAwAINEOE 15 16 <br /> ACCESS CASING,S,E,C/URED/�/ 17 10 <br /> PIPING �j�,t�TC�[" 19 20 <br /> INVENTORY RECONCILIATION E 21 221 1 No <br /> TANK GAUGING E 23 24 <br /> APPROVED RESPONSE PLANK 25 261 1 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29' 301 1 <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 36 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41! L <br /> 1! a2 <br /> "I` POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 45 48 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 531 54 <br /> IMPROPER ABANDONMENT 551 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) F <br /> 57 58 59 <br /> M/�IOFR MINOR NO <br /> VIOL VOL El VIOL Li <br /> wfAll,X4, I\I V�l <br /> - � <br /> QMA1 UN LOCAL HEALTH DISTRII NSP: RECEIVED <br /> POST OFFICE BOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> .VTN: ENVIRON. HEALTH TITLE:,j49[T6IZIAA/ _ PECK (17 �— <br /> M�Trc�5 �I�I.tD LnuJ Tic nubs ' � °. <br />