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r ?• UFN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT •`,:,. " , ''. 609 East Main Street, Stockton, CA 96202-2708 ��-�:�• i Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd �rFOR SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT Facility V Date AV 1'0� Address 3 9c f. t.z< Ccs•, PWS ID # 310 137 1 Type of System REHS WA # Service n "C- Received by Phone # (20e, General Description: This system consists of-well(s)(� of _ ) and _hydropneumatidAbladder/_! storage tank(s) @ gallons. The distribution system consists of service connections serving a population of residents /employees /customers/students. General land use in the surrounding area consists of agricultural, residential, commercial, industrial, rural, pristine, livestock enclosures. Sources of water for: domestic V industrial irrigation fire standby Trealment: Certified Distri buti a n/Treatment 0 perator (CDOICTO): 2c! yL Zoo wilqv,( Cross -Connection Control: All testable backflow prevention devices are required to be tested by a State certified tester annually and immediately after any installation or repair and the results submitted to the Environmental Health Department (EHD). -'2� _ Cross -connection control survey completed/due _ Double Check Valve Assemblies (DCVA) Atmospheric Vacuum Breakers (AVIS) roc I Reduced Pressure Principle Assemblies(RP) ww + Pressure Vacuum Breakers (PvB) w t.'j i Other backflow prevention devices Xcil cc ( a u c3 I C i7ti Wf S �5i o LY V'•`a'r 1V f \Titre 2Z -of the California Code of Regulations requires routine monitoring of your water system by a State certified laboratory. Sampling must be performed by State certified laboratory personnel or CDOICTO. All samples shall be taken at the wellhead, except for bacteriological and Lead and Copper sampling. Please be aware that all results for samples analyzed for a system in a calendar month shall be reported to the EHD no later than the tenth day of the following month. The EHD strongly recommends the use of non - threaded, dedicated sample taps for bacteriological sampling in the distribution system. Bacteriological: Required qua4efly1monthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once each quarter/month. If a Routine samples positive for coliform, instruct your laboratory to col Iect-tQy HOAZRepeats samples within 24 hours of being notified by your laboratory and to collect fifeldlw Routine sample(s) the following month, with the results enumerated and chlorine residuals reported all these samples. Notify EHD if more then one of the samples is positive. Nitrates: Required gaarterly/annua> 0 1 Nitrites. Required quw4ertylonce every threes . Z'2 ca I C) Inorganic Chemicals: Required once every three ears. EHD waived monitoring for asbestos and cyanide. Volatile Organic Compounds (VOCs): Required once every4l4reels . Synthetic Organic Compounds (SOCs): EHD waived monitoring for all SOCs, except for: C) I a DBC P- Re uired once every yklgHthre s and EDB - Re aired once eve three years. I U Lead and Copper: Required once everysitntlthre_ a years. A sample set of lv_elji samples shall be collected from the distributions stem between the months of ,lune through September, Radiological: Gross Alpha/Radium 228: Required quarterly for one year. EHD waived Gross Alpha Imonitorin to once eve 1 / 316 ! 9 ears . rcc.t o2G'�� Secondary (Aesthetics): General Mineral and General Physical are due every three years. Submit a copy of this form with all past due sample results. All past due lab results must be received by: Compliance date for all deficiencies: Please be aware that failure to correct deficiencies by compliance date will result in staff time charges of WIper hour. EHD 46-01 Page 1 of �-� SMALL PIIC WATER SYSTEM OR 10101/07 I.-:* -kx vkyl