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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 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/chd <br /> LIQUID WASTE OFFICIAL INSPECTION REPORT <br /> S=Structure O- eration <br /> NAME OF FACILITY INSPECTION DATE <br /> S O Package Sewage PlJ <br /> 1. 5 <br /> PREMISE ADDRESS REINSPECTION DATE <br /> 2.Lift Pump <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 I��Z� <br /> 8.Blower Aerator <br /> 9. Skimmers Clarification �Q�5 <br /> Ffl2.Effluent <br /> 0. Aerator-Color <br /> 1.Sludge Return <br /> Clarity <br /> 13.Polish Ponds <br /> 14.Excess Sludge <br /> 15.Sludge Bed <br /> 16.Weeds <br /> 17.Distribution Box f 6 5 <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 �� /x� <br /> 24.Monitoring Report <br /> 25.Monitoring Well R-1 L 726 Zt-,-77-4 '� <br /> S O Chemical Toilets <br /> 1.Tank Capacity <br /> 2. Storage Site r <br /> 3. isposal Site IU <br /> 4.Type of Chemicals <br /> 5.Unsanitary Condition <br /> 6.Doors Self Close/Locking <br /> 7.Vector Proof <br /> 8.Surfaces Smooth/Easily Clean <br /> 9.Floor w/Urinal 10 sq.ft. Z <br /> Floor w/oUrinal 8 sq,ft. <br /> 10.Additional Area Inside Hand Washing <br /> 1 I.Lettering Height 3" <br /> S O Pumj2er Trucks/Yards 9� !� <br /> I.Valid PermitlRe istration h` <br /> 2.Pumping Records <br /> 3.Lettering: <br /> Name ,Address 3" ,Ca aci 3" <br /> 3" <br /> Registration Number(6") <br /> 4.Truck Tank: ! 3 <br /> Metal Construction <br /> Leak Proof Valves / - _G <br /> Manual Valves <br /> Valve Location Ct�J <br /> 5.Pum s Sealed -ZI7"v�JC-Y2-0f <br /> 6.Hoses: <br /> Pump Hose Adequate PROGRAM ELEMENT: PROGRAM RECORD: <br /> CleaningHose Adequate <br /> 7.Racks-Metal RECEIVED BY. r DATE: -!�-0 <br /> 8.Yard Sanitation: <br /> Sanitary R.E.H.S. DATE: <br /> Adequate <br /> s Il onoosz ova (�ot!� p[ C'I,jS <br /> 2--8 <br />