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t,4..lN..• >?•�E •.,� SAN .IOAQUIN COUNTY s ENVIRONMENTAL HEALTH DEPARTMENT °Vlld` 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 cdP Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT Facility Date compliance date will result in staff time charges of $139 per hour. Address 3 i5 E. 14�%4Jc (,f 124) PWS ID # /577 Type 4 EHS `, TSL O� WA# &TO z/ Service 7ZounN� Received by Phone #/ '-fv4 General Description: This system consists of G well(s)( and a hydropneumatic/_bladder/ storage tank(s) @_gallons. The distribution system consists ofssF��gj�vvlce connections serving a population of _ residents /.employees /.customers/.students. General land use in thesurroundingarea consists of: agricultural, residential, commercial, industrial, standby rural, pristine, livestock enclosures. Sources of water for: domestic _industrial irrigation fire standby Treatment: �DN6� Certified Distribution/Treatment Operator (CDO/CTO): 7 Cross -Connection Control: All testable backflow prevention devices are required to be tested by a State certified tester annuallyand immediately after any installation or repair and the results submitted to the Environmental Health Department (EHD) by /V _ Cross -connection control survey completed/due _ Double Check Valve Assemblies (DCVA) _Atmospheric Vacuum Breakers (AVB) _ Reduced Pressure Principle Assemblies(RP) _ Pressure Vacuum Breakers (PVB) _ Other backflow prevention devices Any Sanitary Survey Significant Deficiencies? YA@Use of Unapproved Source, Y/&ailure to Monitor/ Report] Verify Data, Y f ailure to meet water demands, YeFailure to contract with CTO/CDO at proper grade, Yaustomers received untreated water. (continued on page 2) Title 22 of the California Code of Regulations requires routine monitoring of your water system by a State certified laboratory. Sampling must be performed by State certified laboratory personnel or CDO/CTO. All samples shall be taken at the wellhead, except for bacteriological and Lead and Copper sampling. Please be aware that all results for samples analyzed for a system in a calendar month shall be reported to the EHD no later than the tenth day of the following month. The EHD strongly recommends the use of non - threaded, dedicated sample taps for bacteriological sampling in the distribution system. Bacteriological: Required geer!a ly/monthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once each eiverter/month. If a Routine sample tests positive for coliform, instruct your laboratory to collect foun4weaRepeats samples within 24 hours of being notified by your laboratory and to collect five/one Routine sample(s) the following month, with the results enumerated and chlorine residuals reported all these samples. Notify EHD if more than one of the samples is positive. 0'Lk 16 Nitrates: Required goakeF�4annually. Nitrites: Required once every three years. Inorganic Chemicals & Perchlorate: Required once every three years. EHD waived monitoring for asbestos and cyanide. 3kwk ) Volatile Organic Compounds (VOCs): Waived to once every six years. Synthetic Organic Compounds (SOCs): EHD waived monitoring for all SOCs, except for: �A I % DBCP- Required once eve Ahree year(s) and EDB - Required once every three years. Lead and Copper: Required once every six months/three years. A sample set of five/ten samples shall be o� �( collected from the distribution system between the months of June through September, & six months later. Radiological: Gross Alpha/ EHD waived Gross Alpha e1.� 1, monitoring to once eve /9 year(s), Secondary (Aesthetics): General Mineral and General Physical are due every three years. Please be aware that failure to correct deficiencies by compliance date will result in staff time charges of $139 per hour. EHD 46-01 5/22/12 Page t of !� SMALL PUBLIC WATER SYSTEM OIR