Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone; (209)468-3420 Fax: (209)468-3433 Web;www.sigov.orq/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: <br /> 1'4 <br /> � I� C-� Perm t Inspection ate: <br /> Parameter/Standard Meets SJC Standards? <br /> Comments/Measureme ts/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes No ❑ NA❑ <br /> Casing extends at least 12" above grade Yes No ❑ NA ❑ <br /> Casing extends at least 1" above pedestal Yes 0 No ❑ NA❑ _ <br /> Free of cracks/contiguous with annular seal Yes 0 No ❑ NA❑ <br /> Graded to allow drainage away from casing Yes [Z No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yest No O NA❑ Omt A M i S) <br /> Seal between all pipe columns and casing Yes 0 No ❑ NA ❑ <br /> Sounding tube/air vents sealed properly Yes ❑ No ❑ NA [A <br /> Chlorination port available and sealed properly Yes V 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 No ❑ NA ❑ <br /> Adequately installed check valve or BFP device Yes E6 No ❑ NA ❑ <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA I <br /> Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA <br /> MAINTENANCE: <br /> Well/Pump visible and protected from damage Yes 2 No ❑ NA ❑ <br /> Well/Pump free from excessive vegetation Yes [✓]' No ❑ NA❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well Yes [jZ 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 [A No ❑ <br /> OTHER: _ <br /> Comments: <br /> Inspected By: Title: <br /> Received By: Date: <br /> =u A,)nn <br />