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;ram <br />Date <br />Service <br />CDO: <br />Page 1 of <br />EHD 46-01-001 <br />Revised 02/13/03 <br />Type of Syste^^ <br />T- A.6fr774/g <br />' XLL PUBLIC WATER SYSTEM PF <br />OFFICIAL INSPECTION REPORT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />304 EAST WEBER AVENUE, 3rd FL, STOCKTON, CA 95202-2708 <br />(209) 468-3420 FAX (209) 468-3433 <br /> Double Check Valve Assemblies (DCVA) <br />Reduced Pressure Principle Assemblie/^LJc^iYU <br /> Other backflow prevention devices 1 <br />WA,6y^/^ <br />Phone # <br /> Cross-connection control survey completed <br /> Atmospheric Vacuum Breakers (AVB) <br />Pressure Vacuum Breakers (PVB^Y | jrfl <br />AU testable backflow prevention devices are required to be tested by a State certified tester annually and immediately after any <br />installation or repair and the results submitted to the Environmental Health Department (EHD). <br />__s, JA' - jf/kvl ~ <br />Title 22 of the California Code of Regulations requires routine monitoring of your water system by a State certified laboratory. <br />Sampling must be performed by State certified laboratory personnel. All samples shall be taken at the wellhead, except for <br />bacteriological sampling. The EHD strongly recommends the use of non-threaded, dedicated sample taps for bacteriological sampling <br />in the distribution system. <br />Bacteriological: Required /rtutraarly/monthlv. Continue testing^}<2r‘24ify/monthly unless a sample tests positive for coliform. After a <br />positive, four repeats must be taken within 24 hours of being notified by your labo'ratory 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 <br />EHD no later than the tenth day of the following month. <br />Nitrates: Required gt^efriy/annually.______________________________________________________ <br />Nitrites: Required ^t^feWy/once every three years. <br />Inorganic Chemicals: Required once every three years. The EHD currently waives asbestos and cyanide. <br />Volatile Organic Compounds (VOCs): Required once every^l?fe//six years. <br />Synthetic Organic Compounds (SOCs): DBCP and EDB are required once every three years. <br />Lead and Copper: Required^jrf^fell^/once every three years. One complete sample set is to be taken <br />between the months of June through September._______________________________________________ <br />Secondary (Aesthetics): General Mineral and General Physical are due every 3 years. <br />Radiological: Gross Alpha & Radium 228 compliance is met by conducting four consecutive calendar <br />quarterly samples. Additional monitoring:_________________________________> /______________ <br />Submit a copy of this form with all past due sample results. *3 <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 in staff time charges of $93 per hour. <br />_______1_ <br />Z-W p,. ei6ffr Mice <br />General Description —ebl '' <br />This system consists of I well(s) and I hydropneumatic tank(s)/bladder tank(s). The distribution system <br />consists of | service connections serving a population of residents/employees/customers/students. General land use <br />in the surrounding area consists of agricultural, residential, commercial, industrial, rural, pristine, livestock enclosures. <br />Well(s) used for: domestic industrial irrigation fire standby <br />Treatment: <br />Cross-Connection Control