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COUNTY NAME # <br /> SITE NAME: E INSPECTION DATE: <br /> SITE ADDRESS: 7 I CITY/STATE/ZIP r <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> MFR/PERMIT SUBMITTED ID# ID# ID* 10 <br /> TYPE OF INSPECTION SITE COMPUTER PER+I PER # PER i PER 0 <br /> > EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJ. MIN. <br /> PERMIT TO OPERATE 1 „ 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3- 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES N 7 8 <br /> APPROVED MONITORING SYSTEM 1: 9 10 <br /> MONITORING SYSTEM OP%TA-FtoN4gC- 111 12 <br /> APPROVED MONITOR FREQUENCY C 131 14 <br /> MONITORING RECORDS MAINTAINED 151 16 <br /> ACCESS CASING SECURED A 171 18 <br /> PIPING i��I-bO� 19 20 <br /> INVENTORY RECONCILIATION 1= 21 22 -7 y 7 <br /> TANK GAUGING F 231 24 — <br /> APPROVED RESPIINSE PLAN/L( 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLNG 29 30 <br /> APPROVED TANK REPAIRS 311 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34' <br /> SAFETY HAZARD 35, 36 <br /> CONDITIONS ABATED 37 VA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 391 1 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 , 42 <br /> POWER DISCONNECTED 43' <br /> OWNER/OPERATOR MONITORING 44, 451 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 461 471 1 <br /> PIPING 48 491 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 531 54 <br /> IMPROPER ABANDONMENT 551 56 <br /> THE MARKEDITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> j <br /> MAJOR 57 Ei MINOR ((58 NO 59 1 ( Z C 9 GDI\I. <br /> VIOL VIOL. Q�9 VIOL ❑ n <br /> _ c � <br /> 5) RA6 IN LOCAL IiEALTH DISTRI NSP: 1Y RECEIVED BY: <br /> POST OFFICC" COX 2009 <br /> STOCKTON. CALIF, 95201 ' <br /> TTN: ENVIRON. HEALTH TITLE:�7/ tTt��t PHONE: RECK: <br /> 7/17/87 Q <br />