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Facility <br />Address <br />WA#REH <br />Received bService <br />mpliance date will result in staff time charges of per hour. <br />SMALL PUBLIC WATER SYSTEM OIRPage 1 of <br />SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT <br />Date <br />ladder/storage tank(s) <br /> residents/employees <br />EHD 46-01 <br />10/01/07 <br />San Joaquin County <br />Environmental Health Department <br />600 East Main Street, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd <br />PWSID# <br />Phone # <br />Please be aware that failure to correct deficiencies b' <br />^^7 C-X , '■'27'7 ST_____________ <br />General Description: This system consists ofx^ well(s)( (33/ ) and / hydropneumatic/ <br />@ gallons. The distribution system consists of S service connections serving a population ofj; <br />/customers/students. General land use in the surroynding-areaconsists of agriculimaLjesidential, commerciaL Industrial rural, <br />pristine, livestock enclosures. Sources of water foCdomestic^y^industrial( rndgation^’^^ fire standby <br />Trea‘ment:Certified Distribution/Treatment Operator^DOTpTO): <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 Q) <br />Cross-connection control survey completed/due Double Check Valve Assemblies (DCVA) <br />><Atmospheric Vacuum Breakers (AVB)Reduced Pressure Principle Assemblies(RP) <br />Pressure Vacuum Breakers (PVBfo^xyT^ag^n Other backflow prevention devices <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-qwai4e4y/R^Hfrrty>or Total coliform bacteria. Instruct your laboratory to collect a Routine sample once <br />each ^aar^mopUr If a Routine sampIeTests positive for coliform, instruct your laboratory to colleotjoyrrtwo Repeats samples within <br />24 hours of being notified by your laboratory and to collect(five/pii0 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-quarterktTannually. j) ______________________________ <br />Nitrites: Required quart&i^yTonce every three yegusx ________________________________________ <br />Inorganic Chemicals: Required once every three years. EHD waived monitoring for asbestos and cyanide. <br />Volatile Organic Compounds (VOCs): Required once ever^^reg^r-yedi'S"' <br />Synthetic Organic Compoundsf^QCsI^-EHp waived monitoring for all SOCs, except for: <br />DBCP- Required-eneo ovory yc^/three yegrffi and EBB - Required once every three years._____________ <br />Lead and Copper: Required once every^pffienffisCfhree yeaca/A sample set a£fiye&ft-6amples shall be collected from the distribution system between the months of June through September, six monthe-iatai— <br />Radiologic^trTjross AlehaTRa^ium 228: Required quarterly for one year. EHD waived Gross Alpha <br />monitoring to once every 1 /3(g^/9 year(s). <br />Secondary (Aesthetics): General Mineral and General Physical are due every three years. <br />Submit a copy of this form with all past due sample results. All past due lab results must be received Compliance date for all deficiencies:.