Laserfiche WebLink
S <br /> 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 Per ection Date: <br /> ►J • Pc_k W i:L r A��P � 8I;@;+// <br /> Comments/Measurements/ <br /> Parameter/Standard Meets SJC Standards? Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes W No ❑ INA ❑ <br /> Casing extends at least 12" above grade Yes © No ❑ NA❑ <br /> Casing extends at least V above pedestal Yes ❑ No ® NA❑ CtS,;mItS)Aa, II abs <br /> Free of cracks/contiguous with annular seal Yes ❑ No 52 NA ❑ <br /> Graded to allow drainage away from casing Yes No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes No ❑ NA ❑ <br /> Seal between all pipe columns and casing Yes © No ❑ NA ❑ <br /> Sounding tube/air Vents sealed properly Yes ❑ No ❑ NA E <br /> Chlorination port available and sealed properly Yes ❑ No ❑ NA EM <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 W <br /> Adequately installed check valve or BFP device Yes [Z No ❑ NA ❑ <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA k2 <br /> Air gap of at least 6" (same as pipe diameter) I Yes ❑ No ❑ NA W <br /> MAINTENANCE: <br /> Well/Pump visible and protected from damage Yes[� No ❑ NA❑ <br /> Well/Pump free from excessive vegetation Yes No D .NA❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well Yes 0 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 0 No ❑ <br /> OTHER: <br /> Comments: kiAd <br /> Cq�(h� <br /> Inspected By: aM Jd Title: C �. (j <br /> Received By: nate: <br /> EH-42.00- 8/31/2015 <br />