Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjgov.oralehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: <br /> Perm Inspection Date: <br /> L_o -bi 00 -T73�� <br /> Parameter/Standard Meets SJC Standards? Comments/Measurements/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes No ❑ NA❑ <br /> Casing extends at least 12" above grade Yes Q No ❑ NA ❑ <br /> Casing extends at least V above pedestal Yes No ❑ NA ❑ <br /> Free of cracks/contiguous with annular seal Yes No ❑ NA ❑ <br /> Graded to allow drainage away from casing JYes E2 No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes ❑ No NA ❑ <br /> Seal between all pipe columns and casing Yes No ❑ NA❑ <br /> Sounding tube/air vents sealed properly Yes No _ NA❑ <br /> Chlorination port available and sealed properly Yes ❑ No_`_.; NA <br /> SAMPLE TAP AND BACKFLOW PREVENTION: <br /> Non-threaded sample tap between well head and <br /> check valve or within 3' of well head Yes ❑ No ❑ NAE9/ <br /> Adequately installed check valve or BFP device Yes No ❑ NA ❑ N° k Va Vt <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/@g flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA <br /> Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA D <br /> MAINTENANCE: <br /> Well/Pump visible and protected from damage YesNo ❑ NA -I El <br /> free from excessive vegetation Yes No F-1NA❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well jYes JNo ❑ <br /> Permit drawing sufficient to locate well in future Yes [0, No ❑ If`no'is selected, attach an accurate map to permit <br /> Photograph taken and attached to record Yes No ❑ <br /> OTHER: <br /> Comments: <br /> W1,tk " 4 ftol (e) <br /> Vr- V-e <br /> Inspected By: Title: Ail 11( � <br /> Received By: Date: <br />