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DATE <br />1»^TZ>C <br />OWNER /OPERATOR <br />TIME OUT <br />ue <br />a (• •egLocation <br />Disinfection <br />aFiltration <br />Treatment Other <br />20 <br />a <br />.at .-V <br />T <br />■O oC* <br />ZV r' \ <br />j 'jltvyC 'l fi-C <br />Turb. Std, Not Met Interm. <br />Turb. Std. Not Met Chronic <br />Pub. Notification Turb. <br />Permit None Valid <br />Source <br />OFFICE ADDRESS AND PHONE NUMBER RECEIVED BY: <br />OF <br />© - <br />I J <br />Storage <br />Distribution <br />m <br />a <br />Inorg. Insutf. <br />Inorg. Std. Not Met Nitrate <br />Inorg. Std. Not Met Selenium <br />Inorg. Std. Not Met Fluoride <br />Inorg. Std. Not Met Mercury <br />Inorg. Std. Not Met Arsenic <br />Inorg. Std. Not Met Other <br />Pub. Notification Inorg <br />Org. Insutf. <br />Org. Std. Not Met Required <br />Org. Std. Not Met Other <br />Pub. Notification Org. <br />Seed. Chem. Insufl <br />Seed. Chem. Std. Not Met <br />Number of Samples Insult <4 Samp. <br />Number of Samples Insult 4-8 Samp <br />Number of Samples Insutf >8 Samp. <br />Std. Not Met For <4 Mo <br />Std. Not Met For 4-8 Mo <br />Std. Not Met For >8 Mo. <br />Pub. Notification Bad. <br />Equip. Maint. <br />Records <br />No Operator <br />Cross-Con. Program <br />Storage <br />Piping <br />Cross-Con. Problem <br />Sewage <br />Activity <br />Flooding <br />Construction <br />MAJOR <br />DEF. <br />MINOR <br />DEF. <br />SMALL WA’ <br />SAN . <br />The marked items represent Health Code violations and must be cor­ <br />rected as follows: <br />e z <br />o! <br />s <br />(Z) <br />< o <br />0 g <br />o s <br />ts2 <br />E <br />o <br />ir <br />LU <br />i o <br />£ <br />s <br />ac <br />z < <br />o <br />Q8 <br />0) <br />pa citA c <br />I <br />' C‘ <br />1 SYSTEM OFFICIAL INSPECTS REPORT <br />ucaAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />445 N SAN JOAQUIN, PHONE (209)468-3420 <br />P 0 BOX 2009, STOCKTON, CA 95201 <br />55 <br />56 <br />57 <br />58 <br />35 <br />36 <br />37 <br />38 <br />39 <br />40 <br />41 <br />42 <br />43 <br />44 <br />45 <br />46 <br />47 <br />48 <br />49 <br />50 <br />51 <br />52 <br />S3 <br />54 <br />Consumer Acceptance Not Met <br />Turb. Insuff. Chronic <br />Turb. Insuff. Interm. <br />COMPUTER NUMBER <br />TIME IN <br />NAME <br />ffy-c iFtc,. ___________ <br />LOCATION <br />J2.3CW £. <^t~rr Hi <br />MAILING ADDRESS <br />_3___ <br />_5___ <br />7__ <br />9 <br />W <br />12__ <br />14___’ <br />16__ <br />18 <br />19 y////, <br />21 <br />24 <br />26 <br />/ /<?■ <br />RECH ECK'DATE 1 <br />±/) <br />/ <br />23 <br />25~ <br />27 <br />28 <br />29 <br />30 <br />31 <br />32 <br />33 <br />34 <br />/6. <br />5S <br />S1 <br />ca ! <br />SANITARIAN: - <br />PAGE L-L <br />Jd-C C Ct <br />3" J Fy <br />(O eg airs <br />yo i- i etc <3 <br />CD s <br />Safety Inadequate <br />SYSTEM STATUS: (MARK ONE) <br />59 60 <br /> M^R <br />EH-154 rev. <br />, tc r-£ <br />( <br />ut. ft. ~i~i j <br />iC trig L <br />r<ece.cf-lcj / <br />iss- <br />MAJOR I MINOR I <br />2 <br />4 <br />6 <br />8 <br />10 <br />11 <br />13 <br />15 <br />17 <br />-C1#. <br />/ rM t yvet- ct ! G' nCiiyet x <br />at y i (TeS ZtJeS. ctC'~X'F, <br />L/eot <br />61 <br />NO I I DEF. || <br />i t~e. <br />f/t '-Cvc t— <br />F <br />2/88 <br />PROGRAM/ELEMENT <br /> V6 <br />7tat