Laserfiche WebLink
ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax; (209)468-3433 Web:www.sigov.om/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: �, �• � � .rte �� � .TO � C� permi Inspe "on bate: <br /> ��l � � 36 063 /6 <br /> u rem en fs/ <br /> ParameferlSfandard Meets SJG Stan dards? Comments/Me <br /> ReGornmendations <br /> omments/MeRecommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes E� No ❑ INA L] <br /> Casing extends at least 12" above grade Yes Y No ❑ INA❑ <br /> Casing extends at least 1" above pedestal Yes Ej ' No ❑ NA❑ <br /> Free of cracks/contiguous with annular seal Yes No ❑ NA❑ <br /> Graded to allow drainage away from casing Yes No ❑ INA❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes No ❑ NA❑ <br /> Seal between all pipe columns and casing Yes Y No 0 NA❑ <br /> Sounding tube/air vents sealed properly Yes ❑] No ❑ NA Ej�/ <br /> Chlorination port available and sealed properly Yes E? No ❑ NA❑ <br /> SAMPLE TAP AND BACKFLOW PREVENTION: <br /> Non-threaded sample tap between well head and <br /> check valve or within 3' of well head Yes Z No ❑ NA❑ <br /> Adequately installed check valve or BFP device Yes No ❑ NA❑ <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑] No ❑ NA <br /> Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA <br /> MAINTENANCE: <br /> Weil/Pump visible and protected from damage Yes [Z No ❑ NA❑ <br /> Well/Pump free from excessive vegetation Yes No ❑ NA❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well IYes ❑7 No ❑ <br /> Permit drawing sufficient to locate well in future Yes No ❑ if`no'is selected, attach an accurate map to permit <br /> 'Photograph taken and attached to record Yes E0 No ❑ <br /> OTHER: <br /> Comments: <br /> Pz <br /> T I� -lZCCl <br /> J C r <br /> nspecfed By: CL," Title: <br /> deceived By: Daze: <br /> cu A Dnn <br /> nt�-t tong� <br />