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' r • ! • r. • • • . <br />• •In <br />rJ <br />s 445 N. San Joaquin Street <br />Melding Address: P.O. Box 388 <br />Stockton, CA 95201.0388 COUNTY # <br />468-3420 <br />SITE NAME:oo_ INSPECTION DATE: <br />® a <br />SITE ADDRESS. i! �- r CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK 1 <br />TANK—a <br />TANK 3 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br /># <br />SITE COMk4 <br />IA Pi -Kr0 <br />A3 %PU6TlEER. <br />" ` ® <br />IMPROPER ABANDONMENT <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />_.. <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />�._.._". <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />F 37 <br />TEMPORARY <br />CLOSUREOWNER/OPERATOR <br />REMOVALOF • <br />MEE <br />VAPORSFLAMMABLE <br />PIPING <br />ACCESS LOCATIONS•m <br />POWER DISCONNECTED <br />MONITORING <br />•• <br />UNAUTHORIZED <br />PERMANENT TANK <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />ME <br />FLAMMABLE VAPORS REMOVED <br />f <br />,11 <br />•• <br />UNAUTHORIZED <br />®® <br />SAMPLING <br />�® <br />IMPROPER ABANDONMENT <br />(MUST MARK ONE) <br />MAJOR 57 M58 59 <br />VIOL. .❑ VIOLO.R ❑ VIOL. ❑ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECT <br />FOLLOWS: TaAtk <br />OFFICE: INSP RECEIVED BY: <br />P <br />TITLE: CjV 0'0 EH g PHONE: BECK: <br />HUT -3 White - Orininal Yellow -Owner's CO®V Pink - Pile Conv <br />