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AQ��N SAN JOAQUIN COUNTY n ENVIRONMENTAL HEALTH DEPARTMENT tK- j 600 East Main Street, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax: (209)468-0341 Web:wwvv,sjgov.org/ehd �1Foa ._ SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT Facility Date Address I ! PWS4D# Type of System REHS WA# i.Service R1 1 Phone#,T eceived General Description: This system consists of-L_well(s)(__ } nd ropneumaticl bladderl / storage tanks) @I[ .�I ns. The distribution system consists of ' service connection ruing a population of residents/?", 'mMMomm eustomersl students. General land use in the surrounding area consists of: agricultural, residential,commercial, industrial, l rural, pristine, livestoc enclosures. Sources of water for: domestic I---industrial If irrigation � fine standby Treatment:!°� _ , Certified Distribution/Treatment Operator(CDO/CTO): litdA /' f �rrvl� Cross-Connection•Control: All testable backflow prevention devices are required to be tested by a State certified tester annually and immediately after any installation or repair and the results submitted to the Environmental Health Department(EHD) by Cross-connection control survey completedldue _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? YIN Use of unapproved Source, YIN Failure to Monitor/Report/Verify Data, YIN Failure to meet water demands, YIN Failure to contract with CTOICDO at proper grade, YIN Customers received untreated water. f�,,�i l6( `� d '/ �'f -ref! •� C"!�'i <.�Z�Ilf//! a �'!' /'1'�t �r f�.`�!1 fl'! .� '.. r/,�-�Ti! �P�'`fG. a,& 1 A Title 22 of the Califo nia Cade of Regulatio s require routine monitoring of your water sys m by a State certified laboratory. Sampling must be performed by State certified laboe{atory personnel or COO/CTO. All samples shall betaken 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 quVterly/roonthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once m each q erlmonth. If a Routine saple tests positive for coliform, instruct your laboratory to collect faf r",o Repeats samples within 24 hours 5T' eing notified by your laboratory and to collect fivelone Routine sample(s)the following month,with the results enumerated and chlorine residuals reported all these samples.Ratify EHD if more than one of the samples is positive. }+( Nitrates: RequiredaecJy/annually. Nitrites: Required once every three years. Inorganic Chemicals& Perchlorate: Required once every three years. EHD waived monitoring for asbestos and cyanide. 6 Volatile Organic Compounds (VOCs): Required once every six years. Synthetic Organic Compounds (SOCs): EHD waived monitoring for all SOCs, except for:14-o'hy DBCP- Required once eve earl s and EDB-Required once eve three years. Lead and Copper: Required once every six monthslthree years. A sample set of five/ten Samples shall be collected from the distributions stem between the months of June through September. &six months later. Radiological: Gross Alpha/Radium 228: Required quarterly for one year. END waived Gross Alpha monitoring to once eve 1/3/619 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$122 per hour. EHD 46-01 8123/10 �- Page t of .--• SMALL PUBLIC WATER SYSTEM OIR a=