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as�PA! c SAN JOAQUIN COUNTY <br /> EN TRONMENTAL HEALTH DEPARTMENT <br /> 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 0= aff- - <br /> S 101 C Package Sewage Pl t NAME OF FACILITY INSPECTION DATE <br /> 1.Grease Trap �S'1�� �� � //-Zd <br /> 2,Lift Pum PREMISE ADDRESS tc REINSPECTION DATE <br /> 3.Fence Locked z�• 1Qb <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 Clarity <br /> 13.Polish Ponds S �'✓ <br /> 14.Excess Sludge <br /> 15.Sludge Bed meati/ �C� CL`l <br /> 16.Weeds <br /> 17.Distribution Box � '2 C <br /> 18.Water Level Pits <br /> 19.Sounding Tube <br /> 20.Intermittent Dosing <br /> 21.Hazard Unsanitary Condition <br /> 22.Yard/Equipment Maintenance <br /> 23.Failure Evident GY%t Cc <br /> 24.Monitoring Report <br /> 25.Monitoring Well <br /> S O Chemical Toilets <br /> 1.Tank CapacityS G� 1rl.�C <br /> 2.Storage Site <br /> 3.Dis22sal Site <br /> 4.Type of Chemicals <br /> 5.Unsanitary Condition /ZCl � 1lL <br /> 6.Doors Self Close/Locking_ <br /> 7.Vector Proof <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 Trucks/Yards <br /> 1.Valid Permit/Registration _ <br /> 2.Pumping Records 7�A � <br /> 3.Lettering: <br /> Mame(Y),Address(3"),Capacity 3" <br /> Registration Number(6") <br /> 4.Truck Tank: <br /> Metal Construction <br /> Leak Proof Valves <br /> Manual Valves <br /> Valve Location <br /> 5.Pumps Sealed <br /> 6.Hoses: <br /> Pump Hose Adequate PROGRAM ELEMENT: PROGRAM RECORD: <br /> Cleaning Hose Adequate 4. <br /> 7.Racks-Metal ECEIVED BY: ATE: <br /> 8.Yard Sanitation: _0 <br /> SanitaryR.E.H. DATE: <br /> Adequate <br /> EHD 42-02-W <br /> 3/10/2005 <br />