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aa�.IH. SAN JOAQUIN COUNTY <br />�y ENVIRONMENTAL HEALTH DEPARTMCNT <br />N: <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 468-3877 Web: www.sjgov.org/ehd <br />WIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: ` Date: <br />Address:ity: Zip Code: <br />Owner/Operator: ' Telephone: <br />Program Element: �. Program Record: 30 3 Inspect n Type: <br />Flow Rate (gpm): <br />(Is <br />pH: <br />Chlorine (ppm): <br />s r c� <br />_k <br />Cyanuric Acid (ppm): <br />p <br />Temp: <br />Reinspecton on or after: <br />Other: <br />RECIRCULATION EQUIPMENT <br />The marked violations represent Health & Safety Code Violations and must be corrected as indicated: <br />❑ Filters <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />❑ Wade Pool — 2 Main Drains <br />SAFETY EQUIPMENT <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 />RESTROOMS <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />WATER QUALITY <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In:ny <br />deceived By: <br />-I, /IV <br />p nspe ted by: <br />- 3 3 <br />Time Out: <br />EHD 36-015-8-12 SWIMMING POOL OIR Page -J,-.f-L <br />