WP0038513 - Laserfiche WebLink

Home Browse Search

) SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East HazeIton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: vvvvw.sigov.orq/ehd \stki--FttttP INSPECTION CHECK LIST • Address: \\11,O — \--W A \A, V) Q‘Lk--s--tk)Q c" e-)t-3--? i Permit#: l ection wtz o s so\ A Date: is i t‘i yi Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: N3 Q t t5t-1(4)-- Dimensions of surface seal (2'x21x4" minimum) Yes E No I NA n Casing extends at least 12" above grade Yes J No ri NA E _ Casing extends at least 1" above pedestal Yes lit No n NA Free of cracks/contiguous with annular seal Yes E No ri NA c Graded to allow drainage away from casing Yes n No Li NA Et • SANITARY SEAL: Well is sealed between pump and casing Yes No I I NA LI Seal between all pipe columns and casing Yes No H NA n Sounding tube/air vents Sealed properly Yes No n NA E Chlorination port available and sealed properly Yes No E NA n SAMPLE TAP AND BACKFLOW PREVENTION Non-threaded sample tap between well head and check valve or within 3' of well head Yes n No n NA -:-J Adequately installed check valve or BFP device Yes No 1-\,,- NA n No cross connections (ex: chemical feeders hooked to distribution systern/ag flood irrigation from domestic supply) Yes LI No El NA E. Air gap of at least 6" (same as pipe diameter) Yes E No LI NA 1,11 MAINTENANCE: Well/Pump visible and protected from damage Yes r\-; No H NA Well/Pump free from excessive vegetation Yes rj No n NA ri MISCELLANEOUS: Permit drawing represents actual location of well Yes No If no is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes No JJ Photograph taken and attached to record Yes No I I OTHER: Comments: cq....v--1/4„14 c •„9c1.-s-c.Pck- , t),,)1. c_R. SpriA i (No NI\ • \X V 4.4', --) • . \ Inspected By: i 1 A ‘0 , ) 4 -: Title: Received By: Date: nInA Jr1/14C