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Facility Date <br />PWS ID <br />WA# <br />Service <br />storage tank(s)bladder/ G <br />residents / <br />Please be aware that failure to correct deficiencies by compliance date will result in staff time charges of $130 per hour. <br />EHD 46-01 11/07/14 Page 1 Of 'L"' SMALL PUBLIC WATER SYSTEM OIR <br />I Double Check Valve Assemblies (dcva)"Erf <br /> Reduced Pressure Principle Assemblies(RP) <br />Other backflow prevention devices <br />’ Y<^Jse of Unapproved Source, Y4?Failure to Monitor/ Report/ Verify Data, <br />to contract with CTO/CDO at proper grade, Y^^ustomers received untreated water. <br />,__ | rehS > , 7 <br />^>0 ,x/771/c <br />l^oun^ iA/^^c^nbty cc^/wct^d vatz* : <br />fe5>v« —_________________________________ <br />^^A5^C> MJ Ann AAetf^L^G <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 or CDO/CTO. All samples shall be taken at the wellhead, except for <br />bacteriological and Lead and Copper sampling. Please be aware that all results for samples analyzed for a system in a calendar month <br />shall be reported to the EHD no later than the tenth day of the following month. The EHD strongly recommends the use of non­ <br />threaded, dedicated sample taps for bacteriological sampling in the distribution system. <br />Bacteriological: Required «t«erteriy/monthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once <br />each^jwarter/month. If a Routine sample tests positive for coliform, instruct your laboratory to collect fourrtwe Repeats samples <br />within 24 hours of being notified by your laboratory and to collect five/one Routine sample(s) the following month, with the results <br />enumerated and chlorine residuals reported all these samples. Notify EHD if more than one of the samples is positive. <br />Nitrates: Required qwartoi4y/annually. __________________________________ <br />Nitrites: Required once every three years. <br />A/cy/ <br />Ib Snorganic Chemicals & Perchlorate: Required <br />- 2-OrT ------ "----:J* <br />^.Oll <br />p&cp: 201-7 <br />spR: Z-oib <br />Address ' <br />____2jrf>O <br />Type of System <br />San Joaquin County <br />Environmental Health Department <br />1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 <br />Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd <br />SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT <br />y/7/>< zz <br />______ <br />V|/4 ocddokk <br />General Description: This system consists of I wellfsw/ ) and [ hydropneumatic/ ^bladder/ 0 storage tank(s) <br />@ gallons. The distribution system consists of (_ service connections serving a population of residents //^Xiployees <br />/customers/students. General land use in the surrounding area consists of: agricultural, residential, commercial, industrial, <br />rural, pristine, livestock enclosures. Sources of water for: domestic industrial irrigation fire u/^standby <br />Treatment: Certified Distribution/Treatment Operator (CDO/CTO): <br />Cross-Connection Control: All testable backflow prevention devices are required to be tested by a State certified tester annually and <br />immediately after any installation or repair and the results submitted to the Environmental Health Department (EHD) by <br /> Cross-connection control survey completed/due <br /> Atmospheric Vacuum Breakers (AVB) <br />j Pressure Vacuum Breakers (PVB) <br />Any Sanitary Survey Significant Deficiencies? <br />Y/^ailure to meet water demands, Y/Jj^ailure 1 <br />1 once every three years. EHD waived monitoring for <br />asbestos and cyanide. L _________________________________________ <br />Volatile Organic Compounds (VOCs): Waived to once every six years. <br />Synthetic Organic Compounds (SOCs): EHD waived monitoring for all SOCs, except for: <br />DBCP- Required once every year/three year(s) and EDB - Required once every three years. <br />Lead and Copper: Reguired once every six months/three years. A sample set of five/tefrsamples shall be <br />collected from the distribution system between the months of June through September, ■froix monlbs latau <br />Radiological: Gross Alpha/Reidiuni 220: Required quarterly fnr one year. EHD waived Gross Alpha <br />monitoring to once every ^at6/fcyear(s). <br /> Secondary (Aesthetics): General Mineral and General Physical are due every three years.