SR0077669 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1-86.8_East_HazelfonAveau_e,_Stocl p-, CA 95205-6232 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.orq/ehd PUMP NS-- ION C ECC UST_ Address• �PrOCg 16 A -C. -m PoS9-0p-1-166 Permit#: Inspe lion gate: I'D X30 Parameter/Standard Meets SJC Standards? CommentslMeasurementsl Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes No ❑ NA ❑ Casing extends at least 12" above grade Yesa No ❑ NA ❑ Casing extends at least 1" above pedestal Yes [2 No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes No ❑ NA ❑ Graded to allow drainage away from casing Yes [0 No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes No ❑ NA ❑ Seal between all pipe columns and casing Yes g No ❑ NA ❑ Sounding tube/air vents sealed properly - Yes ❑ No ❑ NA [0 Chlorination port available and sealed properly Yes ® No ❑ INA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes ❑ No ❑ NA Adequately installed check valve or BFP device Yes V No ❑ NA ❑ k-,svi cfa W No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NAto Air gap of at least 6" (same as pipe diameter) Yes No ❑ NA ❑ MAINTENANCE: Well/Pump visible and protected from damage Yeso No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ NA Cl MISCELLANEOUS: Permit drawing represents actual location of well . Yes No ❑ if 'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes No ❑ Photograph taken and attached to record Yes No ❑ OTHER: Comments: tJ Wt 1( L. US.�LC / jYr1` c'4�, l Ar, Inspected By: S &vI ro n 114-tc1K Title: �c Received By: Date: