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SAN JOAQUIN COUNTY <br /> r.' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sigov.org/ehd <br /> i0b* '�� LIQUID WASTE OFFICIAL INSPECTION <br /> REPORT <br /> S=Structure O-Operation <br /> S O Package Sewage Plant NAME of FACILITY INSPECTION DATE <br /> 1.Grease Trap �� <br /> 2. L it PUm PRE ISE ADDRESS REINSPECTION DA <br /> TE <br /> 3. Fence Locked SU e3 2$ <br /> 4•Cross Connection <br /> 5.Odor The items below present health code violations and must be corrected: <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 I-CIS <br /> 14. Excess Sludge <br /> 15.Sludge Bed <br /> 16. Weeds <br /> 17,Distribution Box <br /> 18. Water Level Pits <br /> 19. Sounding"Tube ic, Le +0 0 CA,L. <br /> 20. Intermittent Dosing <br /> 21.Hazard Unsanitary Condition [CeEH <br /> 22. Yard/Equipment Maintenance it <br /> 23.Failure Evident <br /> 24.Monitoring Report <br /> 25.Monitoring Well <br /> QnCA CA <br /> S O Chemical Toilets <br /> 1,Tank Ca acit Az <br /> 2. Storage Site <br /> 3.Dis sal Site GLr✓C--k CC,iL4F i YAC e .1 <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. 0ote- G -} j SCA C-�-k <br /> Floor w/oUnnal 8 sq. ft. <br /> 10. Additional Area Inside Hand Washing <br /> CA C2 n <br /> 11. Lettering Height 3" <br /> S 10 , Pumper Trucks/Yards <br /> 1. Valid Permit/Registration <br /> 2. <br /> PuT)iiig Records <br /> 3. <br /> Lett <br /> erin <br /> Name 13"),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: 7 7-- PROGRAM RECORD: <br /> Cleaning Hose Adequate 4 l {v <br /> 7. Racks-Metal <br /> RECEIVED BY; DATE: <br /> S. Yard Sanitation: <br /> Sanitary <br /> R.E.H.S. DATE: <br /> Adequate _17 o <br /> EHD 42-02-0Oh <br /> 3!172905 <br />