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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web; www.sjgov.orrq/ehd <br />PUMP INSPECTION CHECK LIST <br />Huu,e55 <br />) oo f ufj`k <br />Pe ©0�6 9 � � <br />nsp ctionDate: <br />P <br />Parameter/Standard _]IMeets <br />SJC Standards? <br />Comments/Measurementsl <br />Recommendations <br />GEMENT PEDESTAL: <br />Dimensions of surface seal (2'x2'x4n minimum) <br />Yes W <br />No <br />- <br />Casing extends at least 12" above grade <br />Yes <br />No <br />Casing extends at least 1" above pedestal <br />Yes 0 <br />No <br />ADNA <br />Free of cracks/contiguous with -annular seal <br />Yes ® <br />No <br />Graded to- allow drainage away from casing <br />Yes <br />No ❑ <br />INA ❑ <br />SANITARY SEAL: <br />Well is sealed between pump and casing <br />YeWE <br />Seal between all pipe columns and casing <br />YesSounding <br />tubefair vents sealed properly <br />YesChlorination <br />port available and sealed properly <br />Yes <br />SAMPLE TAP AND BAGKFLOW PREVENTION: <br />Non -threaded sample tap between well head and <br />check valve or within 3' of well head <br />Yes ❑ ' <br />No ❑ <br />NA hZ <br />Adequately installed check valve or BFP device <br />Yes V <br />No ❑ <br />NA ❑' <br />.9a� <br />No cross connections (ex: chemical feeders <br />hooked to distribution system/ag flood irrigation <br />from domestic supply) <br />Yes ❑ <br />No ❑ <br />NA <br />Air gap of at least 6" (same as pipe diameter) <br />Yes hZ <br />No ❑ <br />NA ❑ <br />