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oP4"1N. SAN JOAQUIN COUNTY <br /> �:•tet_�o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N; t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C'9� F0•RN�P Telephone: (209) 468-3420 Fax: (209)468-3877 Web:www.sigov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: ���L I 4— cc 2_(�A Date: 6 �— j-2_ <br /> Address: =(, `�I I ( ,r'', ,�—'q City: rj�cx� v� Zip Code: <br /> Owner/Operator: hZ.i I- rV r{� Telephone: <br /> Program Element: / �_ Program Record: 0 3(_;C1C Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT T7markedolations re resent Health&Safet Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps <br /> ❑ Chlorinator ( <br /> ❑ Flowmeter cLc <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters 7� �;l\GTi i�uZ ..�al�l ei- .�cDt_ ''v� � ` .•-�-�; 4�c�S���-- . <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover w. CIL- <br /> ❑ Equalizer Line Cover _� 1 IU t r 4�n / <br /> CONSTRUCTION (( ` � <br /> El Pool Shell Cv t1 -( <br /> _ Gj't <br /> ElFencing/Gates l2� �( • _ <br /> ❑ Decking &Coping C r <br /> ❑ Wade Pool-2 Main Drainsir' <br /> SAFETY EQUIPMENT <br /> El Rescue Pole 1 I b r <br /> ❑ Life Ring V14 ::,'(-!f-- h <br /> k4 GF- 7- <br /> El <br /> C- 1❑ Safety Signs _ <br /> ElLifeguard G.c? (_,-' <br /> ❑ Pool/Deck Lighting /vc� - � �S I ( /� ( C \ " <br /> ❑ Ladders/Hand Rails <br /> El Depth Markers/Tiles � r- J <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch n <br /> RESTROOMS p f_C��% CiL)0_-C <br /> ❑ Showers <br /> ❑ Toilet&Dressing 1 cL <br /> ❑ Ventilation C l` L _ L 33`-F 2r <br /> WATER QUALITY <br /> ��'_ Ci Ct� <br /> ❑ Chlorine <br /> ❑ pH •CO ,._ <br /> ❑ Cyanuric Acid Re-46--c <br /> ❑ Clarity <br /> ❑ Test Kits epc f <br /> MISCELLANEOUS <br /> ❑ Supervision&Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: �� Received By: Inspected by: t <br /> Effluent: t <br /> Time Out: <br /> EHD 36-01 5-8-12 SWIMMING POOL OR Pana of <br />