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P. 1n.. SAN JOAQUIN COUNTY <br /> EN\ ,ONMENTAL HEALTH DEPARTA IT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3877 Web:www.sjgov.org/ehd peol <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: L Telephone: <br /> Program Element: '3 j,Q (,. Program Record: '3 Q a-(,(� Inspection Type: �-Q <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric AFid(ppm): Temp: Reinspection on or after: <br /> r--C— ►s1uu LJ Other: <br /> A c C. 3D <br /> RECIRCULATION EQUIPMENT i The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters _ I / -{ hK I�LLr yv uw� (N <br /> ❑ Pumps L �r <br /> E] Chlorinator � ti (1/I 11 { -#,- t Q <br /> ❑ Flowmeterf r9 - ��P%to <br /> ❑ Gauges <br /> ❑ Skimmer&GuttersNY <br /> y yy� �� (Qt G I{c%f. ✓pUly{P <br /> ❑ Back Flow Prevention f' <br /> ❑ Main Drain Cover - �Fl/VLrn 1 <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 /> El [Algae fey�l ✓j h f oc le <br /> Influent: r}SI a I , 3 ,,Flc ,O ( er— (o s- , <br /> Recei . ed By: In pecattee'd by: <br /> Time in: /() f3P <br /> Effluent: I rj r4 2 n 5 • yK f r--- <br /> Time Out: 7 V <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR Page—of <br />