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.sjgov.org/ehd <br /> _ PUMP INSPECTION CHECK LIST <br /> Address: Permit#: Inspection Date: <br /> 1b� 5 • w�i�� �0 . «off L 0.Sz3e we 0o3q 3�\ VS og� Iq <br /> Parameter/Standard Meets SJC Standards? Comments/Measurements/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal 2'x2'x4" minimum) Yes NA❑ <br /> Casing extends at least 12" above grade Yes R INo ❑ NA❑ <br /> Casing extends at least 1" above pedestal Yes © No ❑ NA❑ <br /> Free of cracks/contiguous with annular seal Yes R No ❑ NA❑ <br /> Graded to allow drainage away from casing Yes 0 No ❑ NA❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes [A No ❑ NA❑ <br /> Seal between all pipe columns and casing Yes [I No ❑ NA❑ <br /> Sounding tube/air vents sealed properly - Yes [4 No ❑ NA❑ <br /> Chlorination port available and sealed properly Yes [4 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[j <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 [A NA❑ <br /> Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA <br /> MAINTENANCE: <br /> Well visible and protected from damage Yes No ❑ NA❑ <br /> Well/Pump free from excessive vegetation Yes [I 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'no'is selected,attach an accurate map to permit <br /> Photograph taken and attached to record Yes No ❑ <br /> OTHER: <br /> Comments: <br /> Inspected By: Title: 6 c) <br /> Received By: Date: <br />