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ep4HIH, SAN .JOAQUIN COUNTY <br />ELo'IRONMENTAL HEALTH DEPART rvrCNT <br />". 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />4C/FORa` <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City: <br />y �.� <br />Zip Co e: <br />Owner/Operator: U <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />Flow Rate (gpm): pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Other: <br />Rei sp ction on or after: <br />RECIRCULATION EQUIPMENT <br />The marked violations represent Health & Safety <br />Code Violations and must be corrected as indicated: <br />Filters <br />❑ Pumps <br />❑ Chlorinator <br />-31, <br />❑ Flowmeter <br />a <br />D <br />❑ Gauges <br />�-� <br />A4"j Rt `' <br />r <br />�/ 3 <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />_ <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />rr <br />❑ Pool Shell <br />❑ Fencing/Gates <br />OD <br />HlX <br />❑ Decking & Coping/ <br />. <br />r <br />E] Wade Pool — 2 Main Drains <br />SAFETY EQUIPMENT <br />❑ Rescue Pole <br />V <br />❑ Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />ad <br />❑ Depth Markersrriles <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />RESTROOMS <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />MSSGE1;t:RNCc�uS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: <br />Received By: <br />A✓iyy � q <br />Inspected <br />by: <br />/ <br />Time Out: <br />EHD 36-01 7-18-08 SWIMMING POOL OR <br />