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SAN .JOAQUIN COUNTY <br />EN\,...ONMENTAL HEALTH DEPARTN. jT <br />- 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: V ( L/ <br />Address: City: Zip Code: <br />Owner/Operator: Telephone' <br />Program Element: Program Record: Inspection Type: 419VOW <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Reinspection on or after: <br />Other: <br />RECIRCULATION EQUIPMENT j <br />The marked violations represent Health & SafetyCode Violations and must becorrectedas indicated: <br />❑ Filters . t ^5 <br />y (� a l�A�a�fii w/�✓� <br />❑ Pumps <br />6"41-f- /� 7 �l f7JH PvL%{JY� <br />❑ Chlorinator � ,,, <br />❑ Flowmeter <br />�vv <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />C61 <br />❑ Equalizer Line Cover <br />" CONSITRUCTI'OTI <br />❑ Pool Shell <br />l <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />u <br />❑ Wade Pool - 2 Main Drains <br />SAFETY EQUIPMENT _ <br />❑ Rescue Pole <br />❑ Life Ring <br />❑ Safety Signs <br />v / <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />✓VR <br />❑ Depth Markersfriles <br />I I�Q //-- <br />( QGI' kt W, rhe.- 4-ae' <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />`. REST•RO.OMS _ <br />❑ Showers <br />❑ Toilet & DressingA <br />r 41 <br />❑ Ventilation <br />"". WATER -QUALITY"-`-__ <br />El <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />-"'-MISC.ECLANEOU S- - <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />AA <br />Time In: IReceived <br />Ely: <br />� ns a tp.ad by: <br />'n'-Yh""�" <br />(�4 g'_Q <br />Time Out: <br />EHD 36-01 7-31-09 SWIMMING POOL OR <br />Page 4 of i <br />