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o1!kV. SAN JOAQUIN COUNTY <br /> z EN\ DNMENTAL HEALTH DEPART; 'T <br /> N: [ <br /> .- 1868 Easy Hazelton Avenue, Stockton, CA 95Ao-6232 <br /> Telephone:(209) 468-3420 Fax:(209)468-3877 Web:www.sjgov.org/ehd <br /> S IMMING POOL OFFICIAL INSPECTION REPORT, <br /> Name of Facility: Date: /L <br /> Address: N city: " Zip Code: <br /> Owner/Operator: �„ Telephone: <br /> Program Element: Program Record: "Zj .�j Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reiin�s- ecttion on or after: <br /> Other: V `l <br /> RECIRCULATION EQUIPMENT The marked violations <br /> ,represent Health&Safety Code Violations and must be corrected as indicated: <br /> L1Filters ✓�/� C� C�l� `fpm !�'�Ci/-7 A ✓ <br /> E] Pumps <br /> ❑ Chlorinator _ ' 2 L�1 Gl✓� .� `r �� (,� �1 ( 1�1 <br /> ❑ Flowmeter <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters G(1're, <br /> ❑ Back Flow Prevention <br /> �� <br /> El Main Drain Cover <br /> ❑ Equalizer Line Cover ,�/(/�[ <br /> CONSTRUCTION ww00 /� <br /> ❑ Pool Shell M-- l — �' jinn row � `u'y <br /> ❑ Fencing/Gates ,n141-r;y�K �B` �✓� �1�/L�.t? , <br /> ❑ Decking&Coping <br /> ❑ Wade Pool—2 Main Drains <br /> SAFETY EQUIPMENT a� v <br /> ❑ Rescue Pole <br /> ❑ Life Ring rk <br /> ❑ Safety Signs <br /> ❑ Lifeguard <br /> ❑ Pool/Deck Lighting1�-- <br /> ❑ Ladders/Hand Rails <br /> ❑ Depth Markers/Tiles - <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 /> Influent: <br /> Time In: Received By: Inspected by: <br /> Effluent: rVTime Out: <br /> EHD 36-01 5-8-12 SWIMMING POOL OR Page of <br />