WP0037633 - 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.sinov.om/ehd PUMP INSPECTION CHECK LIST Huwca�- Per io d q5 E, F't`tLEm ,J Lhi /IV f) 633 ctio Date: y Parameter/Standard Meets SJC Standards? Comm ents/Measurementsl Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum Yes M No ❑ NA ❑ - Casing extends at least 12" above grade Yes Q( No ❑ NA ❑ Casing extends at least V above pedestal Yes N� No ❑ NA ❑ Free of cracks/contiguous with -annular seal Yes Z No ❑ NA ❑ Graded to- allow drainage away from casing Yes V ] No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes IV No ❑ NA ❑ Seal between all pipe columns and casing Yes [� No ❑ NA ❑ Sounding tube/air vents sealed properly Yes ❑ No❑ NA ['►� Chlorination port available and sealed properly Yes No ❑ NA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head YesMNo NA ❑ Adequately Installed check valve or BFP device YesNA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) YesNA 0 Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA W IVIAIN l tNAN(yk: Well/Pump visible and protected from damage Yes Well/Pump free from.excessivevegetation Yes MISCELLANEOUS: Pen -nit drawing represents actual location of well Permit drawing sufficient to locate well in future Photograph taken and attached to record OTHER: Comments: No ❑ INA No n INA Yes kj No Yes [j4 No ❑ If 'no' is selected, attach an accurate map to permit Yes IV No (-1 Title: E` r 1'` 4ssf S Received By: . I Date: