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�.. COUNTY NAME • 3 CJ <br /> STTE NAME: ,,{{ INSPECTION DATE: <br /> LG Gc � �1 �a GA-ri c <br /> I ADORESS: �D� o tij ASA CTTY/STATE/ZIPS, A� 9�2�1 <br /> h CHANGES SITE/OWNER/PERW? YES NO ;lD <br /> TANK TANK <br /> e WR/PERMIT 'AX3 GTTED <br /> } b• D•OflgPECTTON SRE COA(t77lTEA• PER ♦ PERPEAS� VE EXP.DATE EXP.DATE E7�.DATE <br /> OPEPATIONAL TANK MAJ. WK <br /> PERMIT TO OPERATE 1 y <br /> 04"q N OONWr"S TO OPERATE 3 l <br /> CONSTRUCTION a 6 <br /> WTYTTEN MON(TpPoNO PpocEOuRES 7 6 <br /> APYR(MO MONTORM.ID SYSTEM 0 ID <br /> MON1TORrNO SYSTEM 11 12 <br /> APPRwEO MONrtOR FREOUENCv R29: 301 <br /> MONrTOR *JG RECORDS MANTNNED <br /> zS� ACCESS CASOdO SECURED <br /> PIPING <br /> NVENTORY RECONCILIATION <br /> TANK CA.00010 <br /> AP'PRO/FO RESPONSE PLAN I .. <br /> UNAUTl4ORQEO RELEASE OCCURRENCE <br /> 301 <br /> SAMPLNo <br /> APPROVEO TANK REPMRS 311 32 <br /> UNAUTHORIZED RELEASES REPORTED 331 34 <br /> SAFETY HAZARD 35, 36 <br /> 00NOrT1pNS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36, 39 <br /> F" FLAMMABLE VAPORS REMOVED b <br /> r4 ACCESS LOCATIONS SEALED 41- 42 <br /> POWER DISCONNECTED 4? <br /> O^4ER/0PERATOR MONrTpmNG {4, 457jil <br /> PERMANENT TANK CLOSURE <br /> nL"ov--L OF nLS4XIAL MATERIALS 461 i7 <br /> 1f <br /> �ti �9 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUT1gR1ZED RELEASE 51 52 <br /> SAMPLJf�/(' 53 S• <br /> 7 <br /> IMPROPER ABANDONMENT SS 56 <br /> SYSTEM STATUS IMVSI MAlIK 011 RIE MARKEO ITEMS REP�RRE SENT VIOLATgNS ANO MUST BE CORRECTED AS <br /> l FOLLOWS YO/ �/� �G--ii•Q._ V�` <br /> sr 519 <br /> MA3OR a Vt� ❑ J/� <br /> VKJL NOVK7L <br /> s ' R56t �qN LOCAL HEALTH OISTRI NSP: V RECEIVED 13Y: <br /> POST OFFICE BOX 2009 <br /> STOCKTON. CALIF. 95201 <br /> N: ENVIRON. HEALTH TTTLE:/< S PHONE HECK <br /> I,I1ti, o- <br />