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Facility Address WA#REHS Service per hour. Page 1 of SMALL PUBLIC WATER SYSTEM OIREHD 46-01 10/01/07 San Joaquin County Environmental Health Department 600 East Main Street, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax: (209) 468-0341 Web: www.sjgov.org/ehd ZAcz aA ->^ Compliance date for all deficiencies: Please be aware that failure to correct deficiencies by compliance date will result in staff time charges of __________________________________I General Description: This system consists of _ / well(s)(-^<^/^ Received by 4<r_. V\ SMALL PUBLIC WATER SYSTEM PROGRAM OFFICIAL INSPECTION REPORT Date 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. Bacteriological: Requiredj^aiiarty/monthly for Total coliform bacteria. Instruct your laboratory to collect a Routine sample once eachz^jarter/month. If a Routine sample tests positive for coliform, instruct your laboratory to collect four/6w Repeats samples within 24 hours of being notified by your laboratory and to collect five/^w& Routine 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 quarterly/once every three years. Inorganic Chemicals: Required once every three years. EHD waived monitoring for asbestos and cyanide. Volatile Organic Compounds (VOCs): Required once every three/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). Secondary (Aesthetics): General Mineral and General Physical are due every three years. Submit a copy of this form with all past due sample results. All past due lab results must be received by:. Phone# _________ Cz£>q) - T'TG ?_________ ) and / hydropneumatic/ J^bladder/storage tank(s) @ gallons. The distribution system consists of service connections serving a population of residents /employees /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 Trea'ment: 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). Cross-connection control survey completed/due Double Check Valve Assemblies (DCVA) Atmospheric Vacuum Breakers (AVB)Reduced Pressure Principle Assemblies(RP) Pressure Vacuum Breakers (PVB)Other backflow prevention devices an _______________/O t DC) Type of System On bcm f/Jen I____tn of c/c< CtrncLoc 11 ■ IO/Z^/CFg PWS ID # „