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�t'•2 SAN JOAQUIN COUNTY <br /> r• =-ate. b (i l/,:,(-. 1 rf 1>n C l� "`�_ <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 <br /> ? Telephone:(209)468-3420 Fax:(209)468-0341 Web:www.sjgov.org/ehd <br /> SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT <br /> Facility , / Date <br /> Address PWS ID ft <br /> Type of System ,"EHS WA# <br /> Service f Received by fj-/CJL)/ Phone k <br /> General Description: This system consists of /I well(s)( and hydropneumatic/_bladder/ storageTanle(s� <br /> � 7 ailons. <br /> The distribution system consists of--&)service connections serving a population of_residents/—employees <br /> /,fix stomers/ students. General land use in the surrounding area consists of:agricultural, residential,commercial,industrial, <br /> rural, riP stine•livestock enclosures. Sources of water for:domestic ✓ industrial irrigation--Z--fire_standby <br /> Treatment: Certified Distribution/Treatment Operator(CDO/CTO): <br /> Cross-Connection Control: All testable backflow prevention devices are required to be tested by a State certified tester annually and <br /> immediately atter any installation or repair and the results submitted to the Environmental Health Department(EHD) <br /> _Cross-connection control survey completed/due —Double Check Valve Assemblies(1)CVA) <br /> _Atmospheric Vacuum Breakers (AVB) V'Reduced Pressure Principle Assemblies(RP) <br /> _Pressure Vacuum Breakers(PvB) _ Other backflow prevention devices <br /> Any Sanitary Survey Significant Deficiencies? Y/N Use of Unapproved Source, Y/N Failure to Monitor/Report/Verify Data, <br /> YM F ilure to meet water--demands,WIN Failure to contract ith� T_O//CDO at proper grade,,GYM Customers received untreated water. <br /> es - - E: k & ;+'l <br /> Title 22 of the California Code of Regulations requires routine monitoring of your water system by a State certified laboratory. Sampling <br /> must be performed by State certified laboratory personnel or CDO/CTO. All samples shall be taken at the wellhead,exceot for <br /> bacteriological and Lead and C000er sampling. Please be aware that all results for samples analyzed for a system in a calendar month <br /> shall be reported to the EHD no later than the tenth day of the following month. The EHD strongly recommends the use of non- <br /> threaded,dedicated sample taps for bacteriological sampling in the distribution system. <br /> Bacteriological: RequiredQjMWie III for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once <br /> eachtua a meRN► If a Routine sample tests positive for coliform,instruct your laboratory to collecY wu a.Reoeats samples <br /> within 24 hours of being notified by your laboratory and to collectfivEfeRe.Routine sample(s)the following month,with the results <br /> enumerated and chlorine residuals reported all these samples. otify EHD if more than one of the samples is positive. <br /> AXiJ4 Nitrates: Required quarterly .nnually.j Uk, ; [L-) <br /> Nitrites: Required once every three years. <br /> Inorganic Chemicals& Perchlorate: Required once every three years. EHD waived monitoring for <br /> asbestos and cyanide. <br /> Volatile Organic Compounds(VOCs): Waived to once every six years. <br /> Synthetic Organic Compounds(SOCs): EHD waived monitoring for all SOCs,except for; <br /> DBCP-Required once every year/three ears and EDB-Required once every three years. <br /> Lead and Copper: Required once every six months/three years. A sample set of five/ten samples shall be <br /> collected from the distributions stem between the months of June through September, &six months later. <br /> Radiological: Gross Alpha/Radium 228: Required quarterly for one year. EHD waived Gross Alpha <br /> monitoring to once eve 1/3/6/9 year(s). <br /> Secondary(Aesthetics): General Mineral and General Physical are due every three years. <br /> Please be aware that failure to correct deficiencies by compliance date will result In staff time charges of j;IOrper hour. <br /> EHD 46-0I 5/22/12 Page 1 of Y SMALL PUBLIC WATER SYSTEM OIR <br />