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ARCHIVED REPORTS_XR0004811
Environmental Health - Public
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EHD Program Facility Records by Street Name
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L
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LOWER SACRAMENTO
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7910
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3500 - Local Oversight Program
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PR0545441
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ARCHIVED REPORTS_XR0004811
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Last modified
3/9/2020 4:57:46 PM
Creation date
3/9/2020 3:06:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004811
RECORD_ID
PR0545441
PE
3528
FACILITY_ID
FA0003733
FACILITY_NAME
NORTH SIDE SHELL
STREET_NUMBER
7910
STREET_NAME
LOWER SACRAMENTO
STREET_TYPE
RD
City
STOCKTON
Zip
95210
APN
07949006
CURRENT_STATUS
02
SITE_LOCATION
7910 LOWER SACRAMENTO RD
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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WELL HEAD INSPECTION CHECKLIST AND RI=P ORDER <br /> Client Sde#W OC-'0glnspection date- 111Z114--77 <br /> Site address 4 ��°� �rt/d /moi` .inspected by � i <br /> ! BTS Event#!Zz ,z <br /> 1. 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 Lid seal intact? Sc Water even with top of well cap? 10 Padlock found locked? <br /> 6 Well cap/plug present? 11 Padlock functional? <br /> Check box if no defrciences were found. Note below deficiencies you were able to correct <br /> Well 1 D. Deficiency Corrective Action Taken <br /> • <br /> I <br /> Note below all deflciences that could not be corrected and st111 need to be corrected <br /> BTS Office assigns or Date Date <br /> Well I D. Persisting Deficiency defers Correction to: assigned corrected <br /> i <br /> i <br /> Office review and assignments made by date <br /> Blaine Tech Services, Inc. File WELLCHK s <br />
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