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COUNTY NAME ♦ <br /> SITE NAME: Ab, A(mAt4t,---,( INSPECTION DATE: <br /> SITE ADDRESS: /7�To arY/STATE/ZIP ire <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED q 0 p• i— q• q s <br /> TYPE OF INSPECTION SITE COMPUTER• PER♦ PER♦ PER PER• <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN <br /> PERMIT TO OPERATE 1 2 / - -1 - <br /> F� CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION N 5 8 <br /> WRITTEN MONITORING PROCEDURES ISI 7 e <br /> s APPROVED MONITORING SYSTEM E 9 10 <br /> MONITORING SYSTEM Oh'rc�Cfk-7E 11 121 1 <br /> APPROVED MONITOR FREQUENCY N 13 141 1 <br /> MONITORING RECORDS MAINTAINED E IS 161 1 <br /> ACCESS CASING SECURED N 17 1B <br /> PIPING 18 201 1 <br /> INVENTORY RECONCILIATION E 21' 22 <br /> TANK GAUGING E 23 24 - <br /> APPROVED RESPnNsE PLAN/V 2s 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29' 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 351 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 MONITORING 44, 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE Ilt 52 <br /> SAMPLING 1.31 54 <br /> IMPROPER ABANDONMENT 551 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: C A! 1 r-(clvh 61,17oM C1v OF <br /> INOR <br /> _ 57 58 59 <br /> NO <br /> VL.. ElM <br /> IOVKX- ❑ VIOL <br /> S WUM1 UN LOCAL HEALTH DISTRI NSR 6 � RECEIVED BY: <br /> POST OFFICE 60X 2009 <br /> STOCKTON. CALIF. 85201 W <br /> N: ENVIRON. HEALTH TITLE: _ "�G` <br /> nnr® O- <br /> r <br />