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-fTE NAME: <br />fTE ADDRESS: Z G <br />tW4GES SITE/OWNER/PERMIT? YES (NO <br />-FR/PERMfT SUBMITTED <br />TANK <br />PER <br />EXP. DATE <br />NSf'ECTIOtJ S1TE COMPUTER <br />)PEWONAL TANK <br />'ERIAT TO OPERATE <br />>4ANGE IN COND1T10NS TO OPERATE <br />,PPROVED <br />VRI'TTEN MONGORING PROCEDURES <br />JPPROVED MON(TORING SYSTEM <br />AON17TORING SYSTEM <br />%P9900YED MONITOR FREQUENCY <br />AON(TORtNG RECORDS MAINTAINED <br />'C GESS CASING SECURED <br />'tPING <br />4VENTORY RECONCILIATION <br />TANK GAUGING <br />kPPROVED RESPONSE PLAN <br />JNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />JNAUTNORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />..OtNOFTiO NS ABATED <br />♦ <br />MAJ. MIN. <br />1 2 <br />EXP. DATE <br />3 4 <br />6 8 <br />7 181 <br />A 1101 <br />11 1121 <br />13 1141 <br />151 1161 <br />171 1181 <br />19 1201 <br />21 ' 22 <br />23 24 <br />25 26 <br />27 28 <br />29' 30 <br />31 32 <br />33 34 <br />35 1 36 <br />/ 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MC+ATORING <br />UNTY NAME * -5 —3 <br />INSPECTION DATE: <br />CITY/STATE/ZIP i, "i, <br />TANK TANK <br />ID*D" <br />10 #0 <br />PER I <br />PER I <br />EXP. DATE <br />EXP. DATE <br />TANK <br />ID I ,/ <br />PER • <br />EXP. DATE <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 461 47 <br />PIPING 48 1491 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTI ORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 58 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTFO AS <br />SYSTEM STATUS (MUST MIRK ONEI FLOWS <br />57 58 59 <br />MA.)OA MINOR NO (� <br />VIOL ❑ VIOL - VIOL <br />WX�UN LOCAL HEALTH DISTRI Nsfl _ B RECEIVED BY. <br />POST OFFICE BOX 2009 -� <br />STOCKTON. CALIF. 95201 <br />AJTN: ENVIRON. HEALTH TITLE: 4"t-1 PHONE: 6] RE CK: <br />►I �,e> 0 <br />s <br />