WP0037728 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone; (209) 468-3420 Fax; (209) 468-3433 Web; www.sigov.orq/ehd PUMP INSPECTION CHECK LIST i...ornmenl.5: r Inspected By: CU -N. INISO ITitle: f--` R -PS -to Received Bv: eu eonn Date: Inspection Date: Address: P0003i"7�c� a Parameter/Standard Meets SJC Standards? Comments/Measuremen / Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes [J1 No ❑ NA ❑ Casing extends at least 12" above grade Yes No ❑ NA ❑ Casing extends at least V above pedestal Yes 2 No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes No ❑ NA ❑ Graded to allow drainage away from casing Yes 1Z No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing IYes%No A ❑ Seal between all pipe columns and casing YesA ❑ Sounding tube/air vents sealed properly Yes A ❑ Chlorination port available and sealed properly Yes A ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes 0 No ❑ NA ❑ Adequately installed check valve or BFP device Yes W] No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA Q Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA [� MAINTENANCE: - Well/Pump visible and protected from damage Yes No ❑ NA ❑ Well/Pump free from excessive vegetation Yes �] No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes 0 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: i...ornmenl.5: r Inspected By: CU -N. INISO ITitle: f--` R -PS -to Received Bv: eu eonn Date: