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SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> 304 EAST WEBER AVENUE, STOCKTON 95201 STOCKTON 468-3420 <br /> LIQUID WASTE INSPECTION FORM <br /> COMPUTER NO _ <br /> PERMIT NO. <br /> DBA inspection D to <br /> STA OPER STR OPER •L��� /`'v `^'�t'� z �7J <br /> PACKAGE SEWAGE CHEMICAL TOILETS(CONT.) Pre—seAddre /1 /^ eche Date <br /> TREATMENT PLANT <br /> _ — 6 DOORS SELF � —J <br /> IGREASE TRAP CLOSE/LOCKING z <br /> % <br /> 2 LIFT PUMP — _ 7 VECTOR PROOF THE ITEMS BELOW REPRESENT HEALTH CODE VIOLATIONS AND MUST BE CORREC fED: <br /> 3 FENCE LOCKED _ _ 8 SURFACES <br /> 4 CROSS SMOOTH/EASILY Y <br /> CLEAN <br /> CONNECT. L .7 <br /> 5 ODOR — -- 9 FLOOR <br /> -- W/URINAL / <br /> 6 VECTOPS 10 SQ FT /S /B J &f et/ <br /> 7 SOIL EROSION — — 8 SO SO FT <br /> _ — 6 BLOWER, — 10 ADDIT. AREA <br /> AERATOR — INSIDE <br /> 9 SKIMMERS- HANDWASH. <br /> CLARIFICATION ; � GV 1 <br /> — 11 LETTERING � i� <br /> � <br /> `C- � S/,s <br /> _ — 10 AERATION- HEIGHT 3" <br /> COLOR PUMPER TRUCKS/YARDS <br /> 11 SLUDGE RETURN <br /> 1 VALID PERMIT/ _-r- <br /> 12 EFFLUENT REGISTRATION <br /> CLARITY _ 2 PUMPING "J <br /> 13 POLISH PONDS RECORDS <br /> 14 EXCESS SLUDGE _ 3 LETTERING j <br /> 15 SLUDGE BED — NAME(31 <br /> ADDRESS 13") <br /> 16 WEEDS CAPACITY(3-) L <br /> 17 DISTR18UTION — REGISTRATION <br /> BOX NUMBER III-) <br /> 18 WATER LEVEL- 4 TRUCK TANK <br /> PITS <br /> _ — METAL <br /> 19 SOUNDING TUCE CONSTRUCTION <br /> 20 INTERMIT. — _ LEAK PROOF <br /> DOSING VALVES <br /> 21 HAZARD- — _ MANUAL <br /> UNSAW COND. VALVES <br /> 22 YARD/EQUIP. — _ VALVE <br /> MAINT, LOCATION <br /> 23 FAILURE — — 5 PUMPS <br /> EVIDENT SEALED <br /> 24 MONIT. REPORT 6 HOSES <br /> 25 MONIT.WELLS — _ PUMP HOSE <br /> CHEMICAL TOILETS ADEQUATE <br /> 1 TANK CAPACITY — — CLEANING HOSE <br /> ADEQUATE <br /> 2 STORAGE SITE — _ 7 RACKS-METAL <br /> _ — 3 DISPOSAL SITE 8 YARD <br /> 4 TYPE OF SANITATION <br /> CHEMICALS SANITARY <br /> 5 UNSANITARY ADEQUATE <br /> CONDITION — <br /> i <br /> Public Healtti 176(4/86) <br /> �$ ITA AN RECEIVED BY l t� <br />