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,UN I Y NAME 0 <br /> TE NAME: CN INSPECTION DATE: <br /> TE ADDRESS: p"go N, CITY/STATE/ZIP <br /> HANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> w:'R/PERMIT SUBMFTTED q > ID 0 / v- q 0 0 s IO• <br />,`PE OF NSPECTION SffE COMPUTER♦ PER I PER PER 0 PER <br /> l SU EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br />)PEF=ONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 2 <br />>W4GE IN CONDITIONS TO OPERATE 3 4 <br />.PPfXNTD CONSTRUCTION 6 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br />-PPI'iO'VED MONITORING SYSTEM 9 10 <br /> Y"ATCONG SYSTEM 11 12 <br />.PPROVED MONITOR FREQUENCY 13 14 <br />,"4(TORtNG RECORDS MAINTAINED 151 16 <br /> C l SS CASING SECURED 171 16 <br />`1PING 19 20 <br /> WENTORY RECONCIIJAT)ON 211 22 <br />(TANK GAUGING 231 24 <br /> LkF'PRONED RESPONSE PLAN 251 263 <br /> Jt,1AUTHORiZED RELEASE OCCURRENCE 27 28 <br /> kSAMPLXJG 29' 30 <br /> OPPRO'VED TANK REPAIRS 31 32' <br />.)NAUTHORIZED RELEASES REPORTED 33 34 <br />,SAFETY HAZARD 351 36 <br />,CONO(T)0NS ABATED 37 rM <br /> TEMPORARY TANK CLOSURE I <br />,REMOVAL OF RESIDUAL 38 jNj <br /> FLAMMABLE VAPORS REMOVED 40 <br /> C[CESS LOCATIONS SEALED 41! 42 <br />,POWER DISCONNECTED M 43 <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 4J54t <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE <br /> SAMPLING <br /> IMPROPER ABANDONMENT 551 58 <br /> THE MARKED ITEMS REPRESENT VIOLAPONS AND_rMUST BE CORRECTED AS <br />!SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> ✓� Cl <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> V,o(_. Elvlot_ ❑ V,QL <br /> IR56 N LOCAL HEALTH DISTRI NSP:: REC,�IVED BY: <br /> POST OFFICE E30X 2009 �! <br /> STOCKTON. CALIF. 95201 BECK: <br /> AjTN: ENVIRON. HEALTH TITLE: �.Lc '�_ ��� f� <br /> 7/17/67 (5•• <br />