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WP0039342
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039342
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Entry Properties
Last modified
4/17/2019 12:04:22 PM
Creation date
4/17/2019 11:16:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039342
PE
4381
STREET_NUMBER
3151
Direction
E
STREET_NAME
NILE
STREET_TYPE
RD
City
MANTECA
Zip
95337-
APN
24133028
ENTERED_DATE
2/27/2019 12:00:00 AM
SITE_LOCATION
3151 E NILE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
DAfonskaia
Tags
EHD - Public
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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.slgov.org/ehd <br />PUMP INSPECTION CHECK LIST <br />Non -threaded sample tap between well head and <br />check valve or within 3' of well head <br />Yes ❑Jf <br />No ❑ <br />NA ❑ <br />Adequately installed check valve or BFP device <br />Yes <br />No ❑ <br />NA ❑ <br />No cross connections (ex: chemical feeders <br />hooked to distribution system/ag flood irrigation <br />from domestic supply) <br />Yes <br />No ❑ <br />NA ❑ <br />Air gap of at least 6" (same as pipe diameter) <br />Yes ❑ <br />No ❑ <br />NA <br />MAINTENANCE: <br />Well/Pump visible and protected from damage <br />Yes <br />No ❑ <br />NA ❑ <br />Well/Pump free from excessive vegetation <br />Yes K) <br />No ❑ <br />NA ❑ <br />MISCELLANEOUS: <br />Permit drawing represents actual location of well <br />Yes <br />INo ❑ <br />If'no' is selected, attach an accurate map to permit <br />Permit drawing sufficient to locate well in future <br />Yes <br />No ❑ <br />Photograph taken and attached to record <br />Yes Ej <br />No ❑ <br />OTHER: <br />Comments: <br />i <br />-- <br />Inspected By: <br />Title: <br />Received By: <br />Date: <br />
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