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ENS _.cONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> DATE <br /> BUSINESS ADDRESS <br /> /GZ P9�1s*cis D21 uc lam. io•o3 <br /> COMPUTER NUMBER <br /> 0WNER'SNAME/08A POLO APP9k'Md;&7's <br /> ME IN <br /> MAILING ADDRESS <br /> PERMIT/LICENSE DROGRwMrELEMENT SERVICE TIME OUT <br /> PATE OF FLOW PM - _ C4 TEMP / OTHER <br /> P 7z P 7. 4 C u P Cav <br /> pmA ..Bts�� PR ys /-To O,O s v I y <br /> d a2 <br /> SIR OPER The marked i e 'represent Health Code violations and must be correctEtL as <br /> Z Filters 1 2 follows: <br /> W <br /> E PUMPS 3 4 <br /> LL ac <br /> Chlorinator 5. 6 lY 1�ISSINa.�ND/N44o( TD SPB 1'r4!s'rP/}NA NEtl7X(i! . REf ire <br /> U., Flowmeter 7 8 <br /> O Gaeges 9' 10 IIHYAf1Dl�']`f, <br /> i= Skimmer d Gutters 11 12 QL► <br /> Je L <br /> Back Flow Prevention 13 14 �P/! /6 � � k)0 <br /> O Waste Water Prevention 15, .16 <br /> U Water Supply a Quality 17. 18: <br /> ¢ Pipe d Fillings 19 <br /> O Pool shall 20 f'['R V)94NEa9 d 4W ex PHxlwEo 4. Tdp /Z•S <br /> 00 Bottom Q Sides 27� 22 1;5 13 PR tvNSN'E,D 5 PA v-6XC7"#j&C r> &V tl'4R� �.� P/aAt Ct. <br /> OQ pecking&Coping 23 24 A <br /> OIMng Boards 25 26i <br /> ReeurePole 2T 28� L-!J ?00 (/}Xls- uifoaa4ete J&PA SeecegfF <br /> Z Life Rings 29 30• <br /> E safety signs 31 32' <br /> Lifeguard El. <br /> O Lighting Elea 341 <br /> U.1 <br /> � Ladders 38' <br /> tu Depth Marken 38-LLFirst Aid Kits 40 4 <br /> Gas Masks 42 43 <br /> Fh Showers 44 45 - <br /> yj0 Toliel6 Dressing 46' 47 <br /> ¢¢ ventilation48; 49. <br /> Chlorine 50 Ue7Y Pool-CQy,PMu?t9-waeNro-ur� S,a9. 4«+ya�GlAaw <br /> pH 51 <br /> Oa Cyenuntee 52: rr HP 1U TSPa Ao f}rsTr4AL vt N 8lsat ffk16 <br /> aO Clarity 53. ;,A L 1 W/a M14T 4"A"(4Test Kin 54' H�►Yk�RD �rK "' <br /> ¢ Su"onsion s Control 55`. <br /> us i44F 4/ E <br /> FGeneral Sanitation 56 <br /> O Miscellaneous 57, NAyWo0.D PRVS rn�. GrtE4`ri <br /> POOL STATUS:(MARK ONE) <br /> ANEW GA4rS aDfi Last <br /> 8 ' 9 F 60 P 1 622 RAyfW< dcwtz(t PonWj> <br /> E a�recei'ry Asp ayMLtfA+GS <br /> Pae1, RH'eevs a <br /> RECEI EO <br /> F]YirO.1 IT mECTIwISf <br /> P <br /> PRS.0�o?r0.951 <br />