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► COUNTY NAME R ? <br /> SITE NAME: ?olrrl�_rwc F � INSPECTION DATE: /I/to v <br /> SITE ADDRESS: �5G CITY/STATE/ZIPS o <br /> CHANCES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED Of ( ID• Z1 ID• ID• <br /> TYPE OF INSPECTION SITE COMPUTER♦ PER♦ PER • PER i PERreofjT_ • <br /> I Fl I EXP.DATE EXP.DATE EXP.DATE EXP.OAIE <br /> OPERATIONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 1 121 / <br /> CHANGE IN CONDITIONS TO OPERATE 3 1 141 <br /> APPROVED CONSTRUCT1pN N 6 1 161 <br /> WRITTEN MONITORING PROCEDURES N 7 1 181 <br /> APPROVED MONITORING SYSTEM 1�_7 9 I I loIX F Nio I NO <br /> MONITORING SYSTEM OPEKA-riOANAI./E 11 12 <br /> APPROVED MONITOR FREQUENCY E 13 14 <br /> MONITORING RECORDS MAWTAMNEDE 15 16 <br /> ACCESS CASING SECURED N 17 1181 <br /> '. PIPING 5 uGTt o tl 191 1201 <br /> INVENTORY RECONCILIATION E 211221 1 <br /> TANK GAUGING E 231 12411 <br /> APPROVED RESPf;vSE PLAN/4 251 121311 <br /> UNAUTHORIZED RELEASE OCCURRENCE 271 12611 <br /> SAMPLING 29' 30 jj <br /> APPROVED TANK REPAIRS 3111 32 <br /> UNALnVIO 11ZEO RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 351 3611 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 1381 1391 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> 'L� POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144, 145i <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 5511 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FpyOWS - <br /> 57 58 59 <br /> VIOL- ❑ VIOL. ❑ I K L❑ <br /> � � I <br /> 5 R56QUN LOCAL HEALTH DISTRI NSP: C, RECEIVED BY: <br /> POST OFFICE E30X 2009 ' <br /> STOCKTON. CALIF, 95201 TITLE I <br /> N: ENVIRON. HEALTH SAKITl421141E PHONE: _ REr� /Ze <br /> 5Y/I�kV �PJILN1�a-�7' �I�.Vc '�-1ZUJ�, � rinisr O• <br /> r <br />