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SAN JOAQUIN fUNTY ENVIRONMENTAL HEAL'I )EPARTMENT <br />304 Fast Weber Ave, 3rd Floor Stockton, CA 952U2-2708 <br />Phone: (209) 458-3420 Fax: (209) 458-3433 Web: WWW.SJCEHD.COM <br />SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT <br />Facility Name: CAYV. - " (' ()()- P �'�RsC— Date: �}•� " Q <br />Address: e3119 E. r^��`K•y CAYNA? ISD • PWS ID #: 1;9 D 17711 <br />Type of System: n4 b3 R.E.H.S.: W �L,L i► WA#: 050611+2- <br />TVDe of Service: RountJE Received By: Phone: <br />GENERAL DESCRIPTION <br />This system consists of Z well(s) and k hydro pneumatic tank(s)—bladder tank(s). The distribution system <br />consists of service connections serving a population of residents/employces/customers/studcnts. General land use in <br />the surrounding area consists of agricultural, residential, commercial, industrial, rural, pristine, livestock enclosures. <br />WELL(S) USED FOR: '1�I7OMESTIC INDUSTRIAL t IRRIGATION FIRE Y STANDBY <br />Treatment: <br />CROSS -CONNECTION CONTROL <br />❑ Cross -Connection Control Survey <br />❑ Atmospheric Vacuum Breakers (AVB) <br />❑ Pressure Vacuum Breakers (PVB) <br />❑ Double Check Valve Assemblies (DCVA) <br />❑ Reduced Pressure Principle Assemblies <br />❑ Other backflow prevention devices <br />All testable backflow prevention devices are required to be tested by a State certified tester annually and immediately <br />after any installation or repair and the results submitted to the Environmental Health Department (EHD). <br />�B ti U� <br />t.4 QAAtI roc, wt N VE - <br />W( <br />4Zcr snN.,VA-9-LI Ptd -,-r-46 n c Gk:+ -f (^t*j & fn L O fWI 5 A'1,9 NO, <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. All samples shall be taken at the wellhead, except for bacteriological sampling. <br />The EHD strongly recommends the use of non -threaded, dedicated sample taps for bacteriological sampling in the distribution system. <br />Bacteriological: Required g0$4esly/monthly. Continue testing rlylmonthly unless a sample tests positive for coliform. After a <br />positive, four repeats must be taken within 24 hours of being notified by your Iaboratory and five routine samples shall be taken the <br />following month. Please be aware that the bacteriological results collected for a system in a calendar month shall be reported to the EHD no <br />later than the tenth day of the#ollowing month. <br />❑-:�p Tt" Nitrates - <br />D [A� Nitrites: <br />three <br />Inorganic Chemicals: Required once every three years. The EHD currently waives asbestos and cyanide. <br />Volatile Organic Compounds (VOCs): Required once every three/six years. <br />Synthetic Organic Compounds (SOCs): DBCP and EDB are required once every three years. <br />Lead and Copper: Required annually/once every three years. One complete sample set is to be taken between <br />the months of June through September. <br />Secondary (Aesthetics): General Mineral and General Physical are due every 3 years. <br />Radiological: Required every four years if compliance is met by conducting four consecutive calendar <br />quarterly samples. <br />Submit a copy of this form with all past due sample results. <br />All past due lab results must be received by: Compliance date for all deficiencies: <br />PLEASE BE AWARE THAT FAILURE TO CORRECT DEFICIENCIES BY COMPLIANCE DATE WILL RESULT 1N STAFF TIME CHARGES OF $89 PER HOUR. <br />EHD 4"1-001 Page I of SPWS Official Inspection Report <br />Revised 02/21/03 <br />