Laserfiche WebLink
COUNTY NAME I <br /> WE NAME: INSPECTION DATE: <br /> SITE ADDRESS: �7�To CITY/STATE/ZIP z, r <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK LANK TANK <br /> MFR/PERMIT SUBMITTED ID I ID I ;-;�- ID I o I <br /> TYPE OF INSPECTION ISITE COMPUTER I PER I PER/ PER/ PER I <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 2 C4- <br /> CHANGE <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTAUCTTON N 5 8 <br /> WRITTEN MONITORING PROCEDURES ISI 7 e <br /> APPROVED MONITORING SYSTEM E 9 10 <br /> MONRORM SYSTEM U)'IE GNI�L-E 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 18 <br /> PIPING 18 201 1 <br /> INVENTORY RECONCILIATION E 21' 22 <br /> TANK GAUGING E 23 24 - <br /> APPROVED RESPONSE PLAN/V 25 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 /> "i POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44, 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48- 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 111 52 <br /> SAMPLING 531 54 <br /> IMPROPER ABANDONMENT 551 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) Fg1OW& C ti( 1G !� L CAI OP-1-76F- <br /> %t l / <br /> _ 57 58 59 <br /> INOR No <br /> VIOL. ElMVCJL ❑ VIOL <br /> S WUM1 UN LOCAL HEALTH DISTRI NSR 6 RECEIVED BY: <br /> POST OFFICE BOX 2009 �`' <br /> STOCKTON. CALIF. 95201 G� T <br /> N: ENVIRON. HEALTH TITLE: t— 0W "AGI <br />