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S A N J O A Q U I N Environmental Health Department <br /> CC•`UNTY - <br /> Water Well Pump Inspection Check List <br /> Owner Name: PARADISO PROPERTIES LLC Water Well Permit: WP0040715 Date: Oct 18, 2022 <br /> Site Address: 1352 N BALDWIN RD Program: 4380-PUMP PERMIT- NEW <br /> STOCKTON, CA 95215 Service type: 050- PUMP INSPECTION <br /> Parameter/Standard IMeets SJC Standards?I Comments/Measurements/Recommendations <br /> CEMENT PEDESTAL <br /> 1 Dimensions of surface seal(2'x2'x4"minimum) o Yes o ■N/A Provide cement pedestal for wellhead. <br /> 2 Casing extends at least 12"above grade n Yes o No o N/A <br /> 3 Casing extends at least V above pedestal .Yes o No o N/A <br /> 4 Free of cracks/contiguous with annular seal n Yes o No o N/A <br /> 5 Graded to allow drainage away from casing ■Yes o No o N/A <br /> SANITARY SEAL <br /> 6 Well is sealed between pump and casing .Yes o No c N/A <br /> 7 Seal between all pipe columns and casing ■Yes o No o N/A <br /> 8 Sounding tube/air vents sealed properly ■Yes D No D N/A <br /> 9 Chlorination port available and sealed properly .Yes o No o N/A <br /> SAMPLE TAP AND BACKFLOW PREVENTION <br /> 10 Non-threaded sample tap betwen well head and check valve or o Yes o No n N/A Provide non-treaded sample tap. <br /> within 3'of well head <br /> 11 Adequately installed check valve or BFP device .Yes o No o N/A <br /> 12 No cross connections(chem feeders hooked to distrubution n Yes n No n N/A <br /> sys/ag flood irrigation from dom supply) <br /> 13 Air gap of at least 6"(same as pipe diameter) o Yes n No .N/A <br /> MAINTENANCE <br /> 14 Well/pump visible and protected from damage .Yes n No n N/A <br /> 15 Well/pump free from excessive vegetation .Yes :7 No f:N/A <br /> MISCELLANEOUS - If"no" is selected, attach an accurate map to permit <br /> 16 Permit drawing represents actual location of well .Yes o No <br /> 17 Permit drawing sufficient to locate well in future .Yes n No <br /> 18 Photograph taken and attached to record o Yes .No <br /> Overall Comments: <br /> Received by: <br /> Date: Inspector: <br /> FRANK GIRARDI, Senior REHS <br /> Printed Name and Title: Inspector Phone: <br /> (209)616-3044 <br /> EHD Rev.05/12/22 Page 1 of 1 Pump Inspection OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />