WP0037040 - Laserfiche WebLink

Home Browse Search

l n v SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT -- — 1-86.8-East_Hazelton_Aven.ue,_StOckt_o_n., CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.slaov.orq/ehd, - ---- PUMP ISPECiFOW-GHECK-.1ST — --- Address: azo r� do(4P, Q -p ��po ParameterlStandard Meets SJC Standards? Perm' : Inctio Date: Ins* bo310 0 ro�3 Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal 2'x2'x4" minimum Yes W No ❑ NA ❑ Casing extends at least 12" above grade Yes W No ❑ NA ❑ Casing extends at least 1" above pedestal Yes [2 No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes WQ No ❑ NA ❑ Graded to allow drainage away from casing Yes Q( No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing YesZ No ❑ NA ❑ Seal between all pipe columns and casing Yes W No ❑ NA ❑ Sounding tube/air vents sealed properly - Yes ❑ No ❑ NA Chlorination port available and sealed properly Yes V No ❑ NA ❑ 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 [9 No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA [� Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA @1 MAINTENANCE: _ Well/Pump visible and protected from damage Yesj7 No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ NA �] MISCELLANEOUS:. _ Permit drawing represents actual location of well . Yes FV No ❑ if 'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes V No ❑ Photograph jaken and attached to record Yes No ❑ OTHER: Comments: Inspected By: GLA4 Title: 6 4 Received By: Date: —., —4.