WP0038272 - Laserfiche WebLink

Home Browse Search

` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95206-6232 Telephone: (209) 468-3420 Fax. (209)468-3433 Web;www.sigoy.orq/ehd g (J PUMP INSPECTION CHECK LOST Address: Pe�" _ /i/' Date:IBPo 003OJ 2 Parameter/Standard I Meets SJC Standards? Comments/Measurements- 1--Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes EZ No ❑ NA❑ Casing extends at least 12" above grade Yes V No ❑ NA ❑ Casing extends at least V above pedestal Yes V No ❑ NA❑ Free of cracks/contiguous with annular seal Yes No ❑ NA❑ Graded to allow drainage away from casing YesVjNoE1 NA❑ SANITARY SEAL: Well is sealed between pump and casing Yes No ❑ NA ❑ _ Seal between all pipe columns and casing Yes No ❑ NA ❑ -- Sounding tubelair vents sealed properly Yes ❑ No ❑ NA NZ Chlorination port available and sealed properly lYes Vr No ❑ INA ❑ 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 V No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA 2K Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NAV MAINTENANCE: Well/Pump visible and protected from damage Yes No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ NA❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes No ❑ Permit drawing sufficient to locate well in future Yes No ❑ lf'no'is selected, attach an accurate map to permit Photograph taken and attached to record Yes V No ❑ OTHER: Gornments: Y"_5 ', Inspected By: A,�.( a f 1`Q Title: (S4'z_A Received By: Date: cu n,)nn nr�a i�na�