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* SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT PWS ID WA# Please be aware that failure to correct deficiencies by compliance date will result in staff time charges of $125 per hour. EHD 46-01 5/22/12 Page 1 Of SMALL PUBLIC WATER SYSTEM OIR San Joaquin County Environmental Health Department 1868 EAST HAZELTON AVENUE, STOCKTON, CA 95205 Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd Bacteriological: Required qwrtorty/monthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once each ^uarier/month. If a Routine sample tests positive for coliform, instruct your laboratory to collect fourflma.Repeats samples within 24 hours of being notified by your laboratory and to collect five/wfgRoutine sample(s) the following month, with the results enumerated and chlorine residuals reported all these samples. Notify EHD if more than one of the samples is positive. Nitrates: Required quarterly/annually. Nitrites: Required once every three years. TZ Inorganic Chemicals & Perchlorate: Required once every three years. EHD waived monitoring for ' asbestos and cyanide._____________________________________________________________________________ Volatile Organic Compounds (VOCs): Waived to once every six years. Synthetic Organic Compounds (SOCs): EHD waived monitoring for all SOCs, except for: DBCP- Required once every year/three year(s) and EDB - Required once every three years.______________ Lead and Copper: Required once every six months/three years. A sample set of five/ten samples shall be collected from the distribution system between the months of June through September, & six months later. Radiological: Gross Alpha/Radium 228: Required quarterly for one year. EHD waived Gross Alpha monitoring to once every 1/3/6/9 year(s). _______________________________________________________ X' Secondary (Aesthetics): General Mineral and General Physical are due every three years. ; & /Vr 71 Title 22 of the California Code of Regulations requires routine monitoring of your water system by a State certified laboratory. Sampling must be performed by State certified laboratory personnel or CDO/CTO. All samples shall be taken at the wellhead, except for bacteriological and Lead and Copper sampling. Please be aware that all results for samples analyzed for a system in a calendar month shall be reported to the EHD no later than the tenth day of the following month. The EHD strongly recommends the use of non threaded, dedicated sample taps for bacteriological sampling in the distribution system. Facility . . Address Received by /o/o& Type of System • Z REHS j X . . T'A/C- Service General Description: @ /-^customers/ students. General land use in the surrounding area consists of: agricultural, residential, commercial, industrial, rural, pristine, livestock enclosures. Sources of water for: domestic industrial irrigation fire standby Treatment: ____________________Certified Distribution/Treatment Operator (CDO/CTO): Cross-Connection Control: All testable backflow prevention devices are required to be tested by a State certified tester annually and immediately after any installation or repair and the results submitted to the Environmental Health Department (EHD) by (Q. Cross-connection control survey completed/due Double Check Valve Assemblies (dcva) Atmospheric Vacuum Breakers (avb) Reduced Pressure Principle Assemblies(RP) Pressure Vacuum Breakers (pvb) O Other backflow prevention devices Any Sanitary Survey Significant Deficiencies? Y^JXlse of Unapproved Source, Y^JFailure to Monitor/ Report/ Verify Data, Y^^ailure to meet water demands, Y/ff^ailure to contract with CTO/CDO at proper grade, Y^pGustomers received untreated water. P,telr)/vo|'2oi^_______ ,_______________________ _______Pno"^A /) M.Q6 fotlfr-. This system consists of / well(s)(,£^P/2-(ir> Jiydropneumatic/ __bladder/storage tank(s) r gallons. The distribution system consists of < service connections serving a population of residents / IT^employees customers/ —'ct'— •