Laserfiche WebLink
SAN 10AQUIN Environmental Health Department <br /> .: --- -C©UNTY---- <br /> �� ' Grearnesi gropys here. <br /> Water Well Pump Inspection Check List <br /> Owner Name: BRAZIL&VAN RYN DAIRY LLC ETAL Water Well Permit WP0040415 Date: May 02, 2022 <br /> Site Address: 18322 E MARIPOSA RD Program: 4369 -WELL AGRICULTURAL <br /> STOCKTON, CA 95215 Service type: 051 - PUMP INSPECTION- NEW WELL <br /> Parameter/Standard iMeets SJC Standards? Comments/Measurements/Recommendations <br /> CEMENT PEDESTAL <br /> 1 Dimensions of surface seal(2'x2'x4"minimum) ■Yes o No n N/A <br /> 2 Casing extends at least 12"above grade ■Yes o No o N/A <br /> 3 Casing extends at least 1"above pedestal ■Yes o No D NIA <br /> 4 Free of cracks/contiguous with annular seal ■Yes n No n N/A <br /> 5 Graded to allow drainage away from casing ■Yes o No D N/A <br /> SANITARY SEAL <br /> 6 Well is sealed between pump and casing ■Yes o No o N/A <br /> 7 Seal between all pipe columns and casing ■Yes n No D N/A <br /> 8 Sounding tube/air vents sealed properly ■Yes o No D N/A <br /> 9 Chlorination port available and sealed properly Yes 1 1 No ■N/A <br /> SAMPLE TAP AND BACKFLOW PREVENTION <br /> 10 Non-threaded sample tap betwen well head and check valve or o Yes �No ■N/A <br /> within 3'of well head <br /> 11 Adequately installed check valve or BFP device ■Yes D No o N/A <br /> 12 No cross connections(chem feeders hooked to distrubution o Yes ■No n N/A <br /> sys/ag flood irrigation from dom supply) <br /> 13 Air gap of at least 6"(same as pipe diameter) Yes ■No N/A <br /> MAINTENANCE <br /> 14 Well/pump visible and protected from damage ■Yes n No D N/A <br /> Wei free from excessive vegetation ■Yes D No o N/A <br /> MISCELLANEOUS - If"no" is selected, attach an accurate map to permit <br /> 16 Permit drawing represents actual location of well .Yee No <br /> 17 Permit drawing sufficient to locate well in future ■Yee No <br /> 18 Photograph taken and attached to record ■Yes No <br /> Overall Comments: <br /> Inspection for pump. No violation found.1grpesti9a-fGF_Pump-.--N0 violation #Qwpd. <br /> Received by: <br /> Date: Inspector: <br /> AARON GOODERHAM, REHS <br /> Printed Name and Title: Inspector Phone: <br /> (209) 616-3062 <br /> EHD Rev.05/12/22 Page 1 of 1 Pump Inspection OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />