Laserfiche WebLink
Y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 9868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sigoy.org/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: ] ,,� <br /> ' L uisc— �V� m`T7v'EG/A Permi �3ggSS l�Oe lln <br /> Parameter/Standard Meets SJC Standards? Commenfis/Measurements/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes V No ❑ NA❑ <br /> Casing extends at least 12" above grade Yes © No ❑ NA❑ <br /> Casing extends at least 1" above pedestal Yes No ❑ NA❑ <br /> Free of cracks/contiguous with annular seal Yes No ❑ NA❑ <br /> Graded to allow drainage away from casing IYes ® No ❑ NA❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes U REDI <br /> ❑ <br /> Seal between all pipe columns and casing Yes ❑ <br /> Sounding tubelair vents seaied properly Yes ❑ <br /> Chlorination port available and sealed properly Yes Qj ❑ <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 Q 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 /> VVe]VPump visible and protected from damage Yes No ❑ NA❑ <br /> VVe]I/Pump free from excessive vegetation Yes No ❑ NA❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well Yes No ❑ <br /> Permit drawing sufficient to locate well in future Yes No ❑ If`n o'is selected,attach an accurate map to permit <br /> Photograph taken and attached to record Yes P1 No ❑ <br /> OTHER: <br /> Comments: <br /> Inspected By: a.L, Title: �"�- <br /> Received By: ADate: <br /> E:u Amann ^ <br />