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`'_ AGRlOU09 TANK 0MCM WSPECTION R. iRT <br /> S".10*AUIN PiI NJO HMTH SERVICES <br /> HNYIAONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COtN1TY NAME Mailing Address: P.O.Box 388 <br /> tea, S� Stockton,CA 95201-0388 COUNTY # <br /> 4x8.3420 <br /> SITE NAME: S�IE-L� 5 r-�VI CE 'a 7rA-110 fd INSPECTION DATE: <br /> SITE ADDRESS: Lv� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 11 PER# I PER#\-4(o0-p3 PER# 1,-:�4,C)-O ek PER# <br /> C-losu�� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS r <~ - <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 � jV EDUVEDMovED Io�ED <br /> APPROVED CONSTRUCTION 5 6 ��/- �y �Z/ c /�t4 kzl /7L,� <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 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 135 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 fV_ 1 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: �1L i�1tC���ti RECEIVED BY: <br /> TITLE: tT-01- k jvv\ PHONE: BECK: <br /> HLIT-3 White-Original Yellow-Owner's Copy Pink-File Copy 5'aa O M• <br />