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WATER INSPECTION FORM <br />COMPUTER NO. <br />PERMIT NO. <br />DBA Inspect!) <br />STR.OPER. <br />SOURCE PROTECTION Ri <br />1 SEWAGE <br />2 ACTIVITY <br />3 FLOODING <br />4 CONSTRUCT <br />5 LOCATION <br />SOURCE TREATMENT <br />6 DISINFECT <br />7 FILTRATION <br />8 OTHER <br />DISTRIBUTION PROTECTION <br />9 STORAGE <br />10 PIPING z <br />11 CROSS CONNECTION <br />OPERATION <br />12 EQUIPMENT MAINTENANCE <br />13 RECORDS <br />14 NO OPERATOR <br />SAMPLING <br />16 BACT SAMPLE INSUFFICIENT <br />17 BACT STD NOT MET <br />QUANTITY <br />22 SOURCE <br />23 STORAGE <br />24 DISTRIBUTION <br />SAFETY <br />25 INADEQUATE <br />SYSTEM STATUS <br />26 MAJOR DEF <br />27 MINOR DEF <br />28 NO DEF <br />SSWS <br />* EH 0318 (1/83)SANITARIAN RECEIVED BY <br />LODI <br />MANTECA <br />TRACY <br />823-7104 <br />835-6385 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. HAZELTON AVENUE, STOCKTON, CA <br />________ <br />Date <br />fheck Dale <br />CLASSIFICATION (CHECK BELOW) <br />sews NCWS <br />21 SECONDARY CHEMICAL <br />STANDARD NOT MET <br />18 PRIMARY CHEMICAL <br />SAMPLE INSUFFICIENT <br />19 SECONDARY CHEMICAL <br />SAMPLE INSUFFICIENT <br />STOCKTON 466-6781 <br />369-3621 <br />20 PRIMARY CHEMICAL <br />STANDARD NOT MET <br />15 CROSS CONNECTION <br />PROGRAM INADEQUATE <br />CZfrTZC <br />Premise Apdress xj _ A/o/ce> ctc^q. <br />THE ITEMS BELOW REPRESENT HEALTH CODE VIOLATIONS AND MUST BE CORRECTED: <br />/ vTT/' Ozzy