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SWIM IG POOL OFFICIAL INSPECTIOV SPORT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTh .aERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 2009, STOCKTON, CA 95201 <br /> BUSINESS ADDRESS DATE <br /> 2y <br /> OWNER'S NAMEIDBA COMP TER WMBER <br /> La S ; <br /> MAILING ADDRESS TIME IN <br /> PERMIT/LICENSE PROGRAMIELEMENT SEg�u/�CE \y�� TIME OUT <br /> 1\©W\ tVI <br /> RATE OF FLOW pH CI. TEMP OTHER <br /> 1- STR OPER The marked items represent Health Code violations and must be corrected as <br /> Z Filters 1 2 follows: <br /> W <br /> a Pumps 3 4 <br /> 0 Chlorinator 5. 6 "jE j r <br /> w Flowmeter 7' { 8 <br /> 0 Gauges 9' '10 <br /> a Skimmer&Gutters 11 112 , <br /> -� Back Flow Prevention 13 s14 <br /> ¢ Waste Water Prevention 15! 116 <br /> Liu <br /> Water Supply&Quality 17 118- n <br /> ¢ Pipe 6 Fittings 19 <br /> Z Pool Shell MM <br /> zv BottomBSides 21! ' 22 <br /> OOD Decking 6 Coping 23 24 <br /> Diving Boards 25 26. <br /> Resure Pole 2T 28 i <br /> Z Life Rings 291 30 <br /> Safety Signs 31 i X3211. 2 W <br /> a Lifeguard 33. <br /> aLighting Elec. 34'' '135 <br /> Ladders 361 ;37 <br /> w Depth Markers 38 I39' <br /> LL <br /> N First Aid Kits 40. !41 I <br /> Gas Masks 142, i43 i LJG l <br /> U) Showers 44, 145 ^-- <br /> f <br /> wO Toilet& Dressing 46 147 �t �, — Sp2O/1 <br /> ¢¢ ventilation 48, 49 - <br /> Chlorine 50, <br /> PH 51 <br /> OOQ Cyanurates 52f <br /> aO Clarity 51 <br /> Test Kits 54! 6 <br /> ¢ I Supervision a Control 554 <br /> w <br /> M General Sanitation 56 <br /> r <br /> O Miscellaneous 57 <br /> POOL STATUS: (MARK ONE) <br /> 58 59 60 61 62 <br /> E ❑ G ❑ F ❑ PD CD <br /> RECEIVED BY: <br /> OFFICE ADDRESS <br /> 445 N. SAN JOAQUIN ST., STOCKTON,CA <br /> (NO MAIL IS RECEIVED AT THIS ADDRESS) S I AR AN: <br /> PHONE (209)468.3420 -14 <br /> PAGE OF <br /> 2188 <br />