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-pu Uz- <br /> COUNTY NAME A l <br /> SrrE NAME: INSPECTION DATE:/U1�1 7 <br /> SITE ADDRESS: ' G CITY/STATE/ZIP l <br /> CHANGES SITE/OWNER/ YES WJK TANK TANK TAW <br /> MFR/PERM<T SUBkVMD p ( p• ` o <br /> D�. <br /> TYPE OF INSPECTION SITE COMPUTER♦ PER it PER 0 PER 0 PER . <br /> _ (Z,Z EXP.DRE EXP.ORE EXP.DATE EXP WE ; <br /> OPERATIONAL TANK MAJ. MIN. <br /> PEF"T TO OPERATE 1 2 <br /> CHANGE N OONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION N 6 6 <br /> WRfTTEN MONITORING PROCEDURES N 7 S <br /> APPROVED MONITORING SYSTEM � 9 10 <br /> k4ONITORINO SYSTEM O I��TI CN A II E 11 12 <br /> APPROVED MONITOR FREQUENCY t4 13 14 <br /> MON�TORNG aEcoRos MAxrrAx�EoE 1s 1s ' <br /> ACCESS CASING SECURED/�/ 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION E 21 221 — <br /> TANII GAUGING E 23 21 <br /> Ai'PfalOVEO RESPONSE PlJ1NN +2528LRAM HORIZ8D,RELEASE OCCURRENCE 28 <br /> SAMPLING E37 <br /> 30 <br /> APPROVED TANK REPAIRS 321 1 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 38 <br /> CONO(TIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESI(x1AL 381391 1 <br /> FLAMMABLE AMPORS REMOVED 44"44 <br /> _ 011,101A <br /> ACCESS LOCATIONS SEALED 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MON(T�ORI14G 451 1 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERMLS 461 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 1531 1641 <br /> IMPROPER ABANDONMENT 55 158 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 58 NO 69 <br /> V10L VIOL ❑ VIOL❑ <br /> ' "69PN LOCAL HEALTH DISTRI NSP. RECEIVED BY: <br /> POST OFFICC BOX 2009 ` 11/V t, <br /> STOCKTON. CALIF. 95201 / <br /> �._N: ENVIRON. HEALTH '�j"1 (l C 2�1� P►+oNE: �g REuc l <br />