WP0040315 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s'gov.org/ehd PUMP INSPECTION CHECK LIST Address: i�'62' - k 5Q15 Permit#: �31� Ins cti9n Date: I I �i91f5 Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes 0 No ❑ NA ❑ Casing extends at least 12" above grade Yes No ❑ NA ❑ Casing extends at least 1" above pedestal Yes [v]' No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes a No ❑ NA ❑ Graded to allow drainage away from casing Yes ❑ No [a NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes Er No ❑ NA ❑ Seal between all pipe columns and casing Yes Z No ❑ NA ❑ Sounding tube/air vents sealed properly Yes []' No ❑ NA ❑ Chlorination port available and sealed proper) Yes [v]' No ❑ NA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes [v]' No ❑ NA ❑ Adequately installed check valve or BFP device Yes No ❑ NA ❑ Any cross connections? (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA ED/ Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA ' MAINTENANCE: Well/Pump visible and protected from damage Yes No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes allo ❑ If'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes No ❑ Photograph taken and attached to record Yes No ❑ OTHER: Comments: large Cr'Q�er tU�d¢r Corker ped�4 C2�, Nor c�rct�sc� "�U G111�w dY aj n cL%R- a w a� OR Inspected By: (L:� n Title: S q }- Received By: J Date: EH -4200- 8/31/2015