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s.x1n.. SAN JOAQUIN COUNTY ' <br /> ' EN, ZONMENTAL HEALTH DEPARTr 'NT <br /> 1868 L—st Hazelton Avenue, Stockton, CA 952vo-6232 <br /> Telephone:(209) 468-3420 Fax:(209)468-3877 Web:www.sigov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: 2. <br /> Program Element: IS UrIt 17 Program Record: Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(pp ): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT T emarked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters Qd <br /> ElPumps <br /> ❑ Chlorinator ` GU <br /> ❑ Flowmeter <br /> ❑ Gauges 4 <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention i <br /> aff go-e4 <br /> E) Main Drain CoverA 0 A <br /> ❑ Equalizer Line Cover <br /> 40 Lf <br /> ❑ Pool Shell D <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping <br /> ❑ Wade Pool-2 Main Drains <br /> SAFETY EQUIPMENT Jlc <br /> ❑ Rescue Pole _ <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 /> RESTROO.MS <br /> ❑ Showers <br /> ❑ Toilet&Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> r <br /> -.. MISCELLANEOUS <br /> ❑ Supervision&Control <br /> v <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: �iece�d By: ks ecd by: <br /> Effluent: I ( nTime Out !lIXXX/// — _ <br /> EHD 36-015-8-12 SWIMMING POOL OIR Page 21 of 4 <br />