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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sagov.org/ehd PUMP INSPECTION CHECK LIST Address: Permit#: Inspection Date: 26940 Walnut Rd., Linden WP0042217 3/8/22 Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal 2'x2'x4" minimum Yes ® No ❑ NA ❑ Casing extends at least 12" above grade Yes ® No ❑ NA ❑ Casing extends at least 1" above pedestal Yes ® No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes ® No ❑ NA ❑ Graded to allow drainage away from casing Yes ® jNoE1 NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes ® No ❑ NA ❑ Seal between all pipe columns and casing Yes ® No ❑ NA ❑ Sounding tube/air vents sealed properly Yes ® No ❑ NA ❑ Chlorination port available and sealed proper[ Yes ® No ❑ NA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non-threaded sample tap between well head and Provide a non-treaded sample tap on check valve or within 3' of well head Yes ❑ No ® NA ❑ wellhead side of checkvalve Provide a checkvalve between the wellhead Adequately installed check valve or BFP device Yes ❑ No ® NA ❑ and storage tank. Any cross connections? (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA N Air gap of at least 6" same as pipe diameter Yes ❑ No ❑ NA MAINTENANCE: Well/Pump visible and protected from damage Yes ® No ❑ NA ❑ Well/Pump free from excessive vegetation Yes ® No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes ® No ❑ Permit drawing sufficient to locate well in future Yes ® No ❑ If'no'is selected, attach an accurate map to permit Photograph taken and attached to record Yes 0 No ❑ OTHER: Abandoned well: Yes ❑ NO ® I Obtain permits to destro the well. Comments: Inactive well: The pump inspection conducted this date revealed the following: 1) No sample tap is provided on the wellhead side of the checkvalve. Install proper sample tap. 2) Provide a checkvalve between the wellhead and.storage tank. 3) The well is not operational and not in use at this time. If the well is not in use for one(1)year, it will be considered an "Abandoned Well" in which it will be required to obtain proper permits to destroy the well. (CA Health& Safety Code Section 115700(a)(b)(d);CA Health&Safety Code, Section 115710; SJC Ord. Code,Title 9, Section 9-1115.5—Well Regulations,SJC Water Well Standards,Section 6.1.). Corrective Action: Obtain proper permits to destroy the well. Inspected By: Frank Girardi Title: Senior REHS Received By: Mailed to: BELLA TERRA LAND CO LLC; 3453 GLENEAGLES DR., STOCKTON., CA 95219. Date: EH-4200- 8/31/2015