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oP1!3 SAN .�OAQUIN COUNTY <br /> ENvi.-cONMENTAL HEALTH DEPARTML-AT <br /> MA&I < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 (� <br /> ' o <br /> �7;FORa�P Telephone: (209) 468-3420 Fax: (209)468-3877 Web:www.sjgov.org/eh <br /> SWIMMING POOL OFFICIAL INSPECTION PO r <br /> Name of Facility: Date: / <br /> Address: City: Zip Code: <br /> Owner/Operator: ` elephone: - 19!30 <br /> Program Element: ( Program Record: ?j b 5b` Inspection Type: <br /> Flow Rate(gpm): H: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health & Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ PUMPS <br /> ❑ Chlorinator A,Ltl /�QAA" 40 t' <br /> ❑ Flowmeter <br /> ❑ Gauges <br /> ❑ Skimmer&GuttersQ <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover V <br /> ❑ Equalizer Line Cover <br /> CONSTRUCTION <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping „( <br /> ❑ Wade Pool—2 Main Drains <br /> SAFETY EQUIPMENT �C 23 <br /> ❑ Rescue Pole J <br /> ❑ Life Ring <br /> ❑ Safety Signs <br /> ❑ Lifeguard <br /> ❑ Pool/Deck Lighting <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 q <br /> Influent: ) <br /> Time In: Received By: Insp cted by: <br /> Effluent: Time Out: (�j to o�5� <br /> EHD 36-01 5-8-12 SWIMMING POOL OR Page-,of <br />