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ARCHIVED REPORTS_XR0006819
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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6131
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3500 - Local Oversight Program
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PR0545003
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ARCHIVED REPORTS_XR0006819
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Last modified
11/27/2019 11:48:20 AM
Creation date
11/27/2019 11:09:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006819
RECORD_ID
PR0545003
PE
3526
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
02
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\wng
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EHD - Public
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WELL HEAD INSPECTION CHECKLIST AND REPAIR ORDER _ <br /> Client Site##2-0ZS2SDlp� Inspection date 1� <br /> Site address�1i� �Uf'__. _ Inspected by <br /> BTS Event# <br /> 1J-Lid on the box?-Yes-No- 5.-{Water standing-in the well box?— 7.-Can-cap be pulled loose? <br /> 2 Lid whole? 5a Standing above well top? 8 Can cap seal out water? <br /> 3 Lid secure? 5b Standing below well top? 9 Padlock present? ---- _ - <br /> •- -4-L-id seal intact?- - 5c.-Water even with top-of well cap?- 10 -Padlock-found <br /> locked?- <br /> 6 Well cap/plug present? J 1 I Padlock functional? <br /> Check box if no deficiences were found. Note befow deficiencies you were able to correct <br /> Well 1 D. Deficiency Corrective Action Taken <br /> / •/j r r <br /> !`l/LuVlee, �r <br /> I-j <br /> l <br /> Note-below all-deficiences that cold riot be^corrected and still need to be corrected. <br /> BTS Office assigns or Date Date <br /> Well I D. Persisting Deficiency defers Correction to: assigned corrected <br /> Office review and assignments made by date <br /> 1 �' Blaine Tech Services, Inc. File WELLCHK s <br />
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