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PAIN... SAN JOAQUIN COUNTY <br /> Q�Qc <br /> 'A.G ENVIRONMENTAL HEALTH DEPARTM T <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> qr <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/chd <br /> LIQUID WASTE OFFICIAL INSPECTION REPORT <br /> S=Structure 0= <br /> S O Package Sewage Pla NAME OF FACILITY INSPECTION DATE <br /> 2. Lift Pump PREMISE ADDRESS REINSPECTION DATE <br /> 3.Fence Locked 2-66'�I e�-7 �f> ' <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 /> 8.Blower Aerator <br /> 9. Skimmers Clarification <br /> 10. Aerator-Color _ <br /> 11.Sludge Return <br /> 12.Effluent Clarity1 <br /> 13.Polish Ponds C/ 7 <br /> 14.Excess Sludge <br /> 15.Sludge Bed C� / <br /> 16.Weeds <br /> 17.Distribution Box 6 <br /> 18.Water Level Pits �� r <br /> 19.Sounding Tube �lf <br /> 20.Intermittent Dosing <br /> 21. Hazard Unsanita Condition 3 / <br /> 22.Yard/E ui ment Maintenance <br /> 23.Failure Evident S r'J Lei'/ Aq <br /> 24.Monitoring Re rt <br /> 25.Monitoring Well <br /> S O Chemical Toilets <br /> 1.Tank Ca acity <br /> 2.Storage Site <br /> 3.Disposal Site <br /> 4.Type of Chemicals }� 1 <br /> 5.Unsanitary Condition /u ''J lc���� /•'�� S'y 7 <br /> 6.Doors Self Close/Locking_ <br /> 7.Vector Proof fL�19 _ /+✓. D <br /> 8. Surfaces Smooth/Easily Clean <br /> 9.Floor w/Urinal 10 sq.ft. X17 G1 �cc <br /> Floor w/oUrinal 8 sq.ft. <br /> 10.Additional Area Inside Hand Washing <br /> 11.Lettering Height 3" _ <br /> S O Pumper Trucks/Yards <br /> 1.Valid Permit/Registration <br /> 2.Pumping Records /PG( <br /> 3.Lettering: <br /> Name(3"),Address(Y),Capacity 3" � <br /> Re istration Number(6") <br /> 4.Truck Tank: <br /> Metal Construction _ <br /> Leak Proof Valves 2 <br /> Manual Valves <br /> Valve Location <br /> 5.Pumps Sealed <br /> 6.Hoses: <br /> i( cl <br /> Pump Bose Adequate PROGRAM ELEMENT: /LZ�/ PROGRAM RECORD: <br /> CleaningDose Adequate <br /> 7.Racks-Metal RECEIVED BY: f- ATE: <br /> 8. Yard Sanitation: C� <br /> Sanita R.E.H.S. DATE: <br /> Adequate l �8 <br /> EHn 42-02-006 <br /> 4 3110;2005 d 4211 y /Z! LC <br /> M4rn_''7-�uPU2. <br />