WP0038955 - 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.org/ehd PUMP INSPECTION CHECK LIST Address: f 7, j, S� 1cGIP �r'� !!� Permit#: IInspection Date: 1/ -" r Parameter/Stand Meets 5JC Standards? Com mentslMeasurements/ard Recommendations CEMENT PEDESTAL: Dimensions of surface seal 2'x2'x4" minimum) Yes X No ❑ NA ❑ Casing extends at least 12" above grade Yes ❑ No NA ❑ W e( Casing extends at least 1" above pedestal Yes ❑ No 9 NA ❑ Free of cracks/contiguous with annular seal Yes No ❑ NA ❑ Graded to allow drainage away from casing Yes 9. No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes X No ❑ NA ❑ Seal between all pipe columns and casing Yes [K No ❑ NA ❑ Sounding tube/air vents sealed properly - Yes]< No ❑ NA ❑ Chlorination port available and sealed properly Yes,K No ❑ NA ❑ _ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes X No ❑ NA ❑ Adequately installed check valve or BFP device Yes No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA rZ Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA M MAINTENANCE: Well/Pump visible and protected from damage Yes No ❑ 1 NA ❑ _ Well/Pump free from excessive vegetation Yes FA No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well YesW 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: Comments: (asina� •exA-eoJ 44,-,oN (P I -�rc�N� rtdP . Cos ,pX _�4 . 5 " a bo Pups}a (• w P (1 �', , �q 11-�,� ' K X 0 0 2. Inspected By: A StM Title: Deceived By: Date: