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COUNTY NAME • <br /> INSPECTION DATE: <br /> SITE NAME: ' � R _> . <br /> SITE ADDRESS: q C q F- �I t r C"/STATE/ZIP hl altii�z r� <br /> CHANCES SITE/OWNER/PERMIT? YES NO TANK t TANK TANK TANK <br /> MFR/PERMIT SUBMITTED D• LOAs�L cr� D� w-gsYe o,l ID• D• <br /> TYPE OF NISPECTION SITE COMPUTER♦ PER 0 '�sC 'i PERI iS U PER• PER <br /> I <br /> -�/Tc � � .''c G.-,'r��7 I < .' _'j EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OpERATK NAL TANK MA.L MIK <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 131 <br /> APPROVED CONSTRUCTION 161 161 <br /> WRITTEN MONITORING PROCEDURES 171 181 <br /> APPROVED MONITORING SYSTEM B 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONROR FREQUENCY 19 14 <br /> MONITORING RECORDS MAINTAINED 15 16 L <br /> ACCESS CASINO SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21' 221 V <br /> TANK GAUGING 1231 1241t/ L— <br /> APPROVED RESPf;IvSE PLAN 251 1261 , <br /> UNAUTHORIZED RELEASE OCCURRENCE 1271 1261 <br /> SAMPLING 29' 3D <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 38, 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41' 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MOMTORING a4 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE St 52 <br /> 777777 <br /> SAMPLING <br /> IMPROPER ABANDONMENT 55 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) fOlLOWS: <br /> LCC � �'�� !L`�-o fL .--1��✓ <br /> _ _ <br /> 57 58 59 <br /> MA" MINOR NO <br /> VIOL. ❑ vaL VIOL41 Zzdfo L22"'64 <br /> ❑ - ' G ' F �c1 ' ltd_ <Et <br /> s P� %✓^fP� � � C2 !% �i Gc� <br /> S R56K�tlIN LOCAL IiEALTH DISTRI NSP: RECEIVED H. <br /> POST OFFICE BOX 2009 � � �C=c <br /> STOCKTON. CALIF. 95201 PHONE: RECK: <br /> TT <br /> N: ENVIRON. HEALTH <br />