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a pklp. SAN JOAQUIN COUNTY <br />ESI IONMENTAL HEALTH DEPARTF 'NT <br />1868 East Hazelton Avenue, Stockton, CA 952:,-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPO/RT, <br />Name of Facility: <br />Date: <br />Address: w <br />City: <br />Zip Code: <br />Owner/Operator: <br />.i <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />Flow Rate (gpm): <br />�5 <br />pH: <br />7-� <br />Chlorine (ppm): <br />5, 0 � <br />cc, <br />Cyanuric Acid (ppm): <br />/-30 <br />Temp: <br />Reinspection on or after: <br />Other: <br />RECIRCULATION EQUIPMENT <br />The marked violation represent Health & Safety <br />Code Violations and must be corrected as indicated: <br />❑ Filters <br />f 6ti <br />- <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />❑ Pool Shell _ <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />❑ Wade Pool - 2 Main Drains <br />SAFETY EQUIPMENT <br />❑ Rescue Pole <br />❑ Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />❑ Depth Markers/Tiles <br />- <br />-- - <br />- ----- <br />- -- <br />- - <br />------ <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />RESTROOMS <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />WATER:QUALITY <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />-' MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />f <br />�[ <br />Influent: <br />/� L <br />V P J I <br />,(„Q <br />Ti mein: 1 U Sn <br />Time out: I �� <br />Received y: <br />=ee y:Effluent: <br />JJ <br />EHD 36-015-8-12 SWIMMING POOL OIR Page of <br />