WP0037594 - 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 Address:i O t C �o n Perms Ins tl OD3i6 r� Parameter/Standard Meets SJC Standards? Com eGOM M nclati ments/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal 2'x2'x4" minimum Yes 2 No ❑ NA ❑ Casing extends at least 12" above grade Yes ® lNo ❑ NA ❑ Casing extends at least 1" above pedestal Yes 12 No ❑ NA ❑ Free of crackslcontiguous with -annular seal Yes No ❑ NA ❑ Graded to- allow drainage away from casing Yes © No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes No ❑ NA ❑ - Seal between all pipe columns and casing Yes ® No ❑ NA ❑ Sounding tube/air vents sealed properly Yes ❑ No ❑ NA V 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 1W No ❑ NA ❑ Adequately installed check valve or BFP device Yes V No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA JZ Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA R MAINTENANCE: Well/Pump visible and protected from damage Yes No F-1Well/Pump free from. excessive vegetation Yes �j No +ENA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes Q No ❑ If `no' is selected, attach an accurate map to per; nig Permit drawing sufficient to locate well in future Yes No ❑ Photograph taken and attached to record Yes No ❑ OTHER: Comments: Inspected By: CA,41 Title: to + tI A}j Received By: Date: