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Envirc, jental Health Department <br />HP & Capacity CommentsStatus <br />(gpm)(A, I, Stby) <br />SubmersibleWellAY <br />WellWell Name: <br />SubmersiblePump type/Lubrication <br />YesLocked/Fenced? <br />3’x 4’Surface Seal size? <br />Appears serviceable <br />NoOpenings in wellhead? <br />Screened J-ventCasing Vent/Screens? <br />Drainage away?Yes <br />Senses flow meterFlow Meter/Type? <br />Sample Tap? <br />Chlorine Injection Port? <br />Well Log on file? <br />No <br />SWAP completed for each source? <br />Surrounding Land Use: <br />Susceptible to: <br />If no SWAP on file, request PCA checklist and Well Data Sheet. <br />3 of 6 <br />Concrete <br />Thickness/Cracks? <br />Pump to Waste? BF <br />prevention? <br />Maintaining monthly production records? <br />Emergency Chlorination capability? <br />(Power supply & injection port) <br />Source <br />Name <br />Waste discharge is d/s of <br />check valve, tank, and <br />flow meter <br />Threaded, downturned <br />hose bib <br />d/s of check valve <br />Type (DWT/Subm) & <br />Lubrication <br />Threaded? Downtrned? <br />U/S of CV? <br />Metered? <br />(Y/N) <br />SANJOAQUIN <br />-----COUNTY------