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a4�I� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> LIQUID WASTE OFFICIAL INSPECTION REPORT <br /> S=Structure peration <br /> S O Package Sewage Plant NAME OF FACILITY INSPECTION DATE <br /> Grease Tra <br /> 2 PREMISE ADDRESS REINSPECTION DATE <br /> 3.Fence Locked <br /> 4.Cross Connection The items below present health code violations and must be corrected: <br /> 5.Odor <br /> 6.Vectors _ <br /> 7. Soil Erosion <br /> S.Blower Aerator <br /> 9.Skimmers Clarification / S/���' �A�t/ <br /> 10.Aerator-Color _ <br /> 11.Sludge Return <br /> 12,Effluent Clarity <br /> 13.Polish Ponds <br /> 14.Excess Sludge <br /> 15.Sludge Bed <br /> 16.Weeds <br /> 17.Distribution Box e2 :�22 <br /> I S.Water Level Pits <br /> 19.Sounding Tube •4>4 ;o 7!� <br /> 20.Intermittent Dosing ' <br /> 21.Hazard Unsanitary Condition 90 429Qf YL �L <br /> 22.Yard/Equipment Maintenance _ <br /> 23.Failure Evident <br /> 24.Monitoring Report <br /> 25.Monitoring Well �fS <br /> S O Chemical Toilets <br /> 1.Tank Capacity P/2'/--,r Y+at/ <br /> 2.Stora e Site I%` ; <br /> 3.Disposal Site <br /> 4.Type of Chemicals <br /> 5.UnsanitM Condition <br /> 6.Doors Self Close/Locking <br /> 7.Vector Proof 1n11zbt &E- S A,,t77,!5n ,Z <br /> 8.Surfaces Smooth/Easily Clean <br /> 9.Floor w/Urinal 10 sq.ft. <br /> Floor w/oUrinal 8 sq.ft. <br /> 10.Additional Area Inside Hand Washing <br /> 11.Lettering Height 3" <br /> S O Pumper TruckslYards l�C ~' l�� 4)0- ZC_ <br /> 1.Valid Permit/Registration <br /> 2.Pumping Records S <br /> 3.Lettering: <br /> Name 3' ,Address(3"),Capacity 3" <br /> Registration Number(6" <br /> 4.Truck Tank: {!�/��4 e8 aos a t7 0 2- <br /> Metal Construction 1 <br /> Leak Proof Valves <br /> Manual Valves <br /> Valve Location <br /> 5.Pumps Sealed <br /> 6.Hoses: <br /> Pump Hose Adequate PROGRAM ELEMENT: ��y PROGRAM RECORD: �r <br /> Cleaning Hose Adequate TI�Tv` 9 <br /> 7.Racks-Metal RECEIVED BY: DATE: <br /> 8.Yard Sanitation: 'S <br /> Sanitary R,E y.S. DATE: <br /> Adequate <br /> EHD 2 <br /> 3110/2005 � � � -64S'�vc-a- <br />