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SAN JOAQUIN COU;NP! ENVIRONMENTAL HEA;.-TH <br /> SMALL 1PUBLIC WATER SYSTEM <br /> POS!I pVF_ TOTAL COLIFO5RM L11VES s IGATION <br /> AUTHORITY: CA�LiFORAHA CODE OF REGULAT oms, 7ITLF 22; SECTION 64426(B) <br /> This form is intended to assist Small Public Water Systems with completion of a Positive Total Goli orn-L(TC) Inves•tig_,i for for exceeding the <br /> Total Coliform Rale(7CR} Maximum Coretaminant,Levels (NICL) <br /> o',PdSID NUMBER: NAME PHONE NUMBER E-MAIL ADDRESS <br /> WATERSYSTEivi 3`{a '31� "eV, oi-� GQV Fr ��/ ��" - 1 <br /> Certified Operator(CDO/CTO): :J ccnk— r " cc�o ofo o co�ti,�. <br /> Pro erty Owner: <br /> Certified L aboratory _A2 (,ul�S� !.4 a2'i4�`��45' LoF - Lc ,A-, !'wt, t� cc ,Qt'01^ <br /> SAMPLE SI T_--S SAMPLE DATE RESULTS FOR: List the Last 12 Months that had a TCR MCL <br /> TC MPN E. COLI MPN CHLORINE PPM Violation <br /> 1 Well lD 3a o I '311 -oPI <br /> r <br /> c 1lUa1; iD 1.� `� � ► � (tl�,`1cNCri.(1� Lc: 7. <br /> Pressure Tank _ 2• E• I <br /> IROUT,HNE <br /> REP EAT•i 10. <br /> REPEAT 2 5 11. <br /> REPEAT-3 6 2 <br /> REPEAT 4 - vza•y� ��le -- <br /> OTHER <br /> OTHER <br /> I <br /> OTHE. <br /> '`iVES T IGA T[ N: <br /> Review the results above. If the vvell is positive, then determine if the well is contaminating the system, or is the system contaminating the well. <br /> To determine this inspect the wellhead for a functioning check valve. is it present? YIN. Is it functioning to prevent system water from draining back into <br /> the well? YIN. To verify this, open the sample tap installed on the well side of the check valve, when the well is off. If water runs out of the tap, then the <br /> check valve is not functioning/se-aling properly. Water will not run out of the tap when the well pump is off, if the check valve is functioning. <br /> If the valve leaks water back into the well, then the source of the contamination may originate down stream of the vrell. If the check valve is holding, then most <br /> iikeiy the well is the source of the contamination. <br /> iF THE;a'VELL IS CONTAMINATiNG THE SYSTEM: <br /> Perform, a physical inspection as itemized in the SOURCE section. Determine if the contamination was caused by a structural deficiency at the surface of the well <br /> head or the construction/deterioration of the well. <br /> I:_'_es iis�w the operator to determine if maintenance to the well or pump took place since the last-absent TC results. (were well components replaced or repaired, <br /> v,+e:lihead seal broken, chlorination or sounding of the well performed, etc.) <br />