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COUNTY NAME i 7� <br /> SITE NAME: INSPECTION DATE: a//0 <br /> SITE ADDRESS. a S ' ( CITY/STATE/ZIP .� <br /> aW413ES SITE/OWNER/PERMIT? YES CNOTANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED ID i ID ID 0 ID i <br /> TYPE OF INSPECTION SITE COMPUTER i PER i PER i PER i PER i <br /> V O U lz EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK kW. MIN. <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION t-1 5 8 <br /> WRITTEN MONITORING PROCEDURES N 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM O PF-KA-T(ON A L E 11 12 � <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINEDE 15 161 1 <br /> ACCESS CASING SECURED/�� K24 <br />�f PIPING �Z���1l,f, <br /> INVENTORY RECONCILIATION E <br /> TANK GAUGING F <br /> APPROVED RESP(INSE PLAN/\4 <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD CONDITIONS ABATED <br /> VIA- <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 -391 1 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 ! 42 <br /> Il+ POWER DISCONNECTED 92 43 <br /> OWNER/OPERATOR MONITORING 44, 45i <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 511 52 <br /> SAMPLING 53 1 54 <br /> IMPROPER ABANDONMENT 551 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) dWS: ( I L <br /> FZ � <br /> (57 58 59 <br /> VIOL- <br /> MAJOR <br /> KX ❑ MINOR <br /> ❑ VIOL❑ <br /> R' t�U6 I l0 <br /> 9116KOUN LOCAL HEALTH DISTRI NSP: R CENED BY: <br /> POST OFFICE BOX 2009 A y� <br /> ,TOCKTON. CALIF. 95201 ►G <br /> "TN: ENVIRON. HEALTH TITLE:C��fl I T�q T?)►4/� PIIONE. RECK <br /> ry <br /> Jf/7 STc/L6l?5</ co&ro fr &- <br />