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�.�.In.. SAN JOAQUIN COUNTY <br /> EI. IRONMENTAL HEALTH DEPART ,.TENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: �]a <br /> Address: City: MdLz Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type• -�- 02_0 <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENTThe marked violations represent Health &Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters s .{e. Pao <br /> ❑ Pumps i Gf/TAa�t <br /> ❑ Chlorinator <br /> ❑ Flowmeter p <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention e 9 <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover U rr - <br /> ❑ Pool Shell fi 1A)W r "r <br /> ❑ Fencing/Gates O� <br /> ❑ Decking&Coping <br /> ❑ Wade Pool-2 Main Drains _� <br /> .:SAFETY EQUIPMENT <br /> ❑ Rescue Pole <br /> ❑ Life Ring <br /> ❑ Safety Signs (POLO 114 `/•/F$/moo <br /> El Lifeguard 1,1W Lbv <br /> ❑ Pool/Deck Lighting r Q <br /> ❑ Ladders/Hand Rails a <br /> v <br /> ❑ Depth Markers_ <br /> /Tiles <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch , <br /> Q <br /> -RESTR OOM5 <br /> ❑ Showers <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation — �y <br /> ❑ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits V )(010 s <br /> ❑ Supervision &Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: Received B spe c eyd bby�: <br /> Effluent: Time Out: �` '�'"""'•'IY <br /> EHD 36-017-31-09 SWIMMING POOL OR Page of <br />