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SAN JOAQUIN COUNTY <br /> B RONMENTAL HEALTH DEPART NT <br /> u• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �a <br /> Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: % - — Date: <br /> Address: city: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: / gram Recor . edin Type: / <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric pm): TOAV. Reinspection on or'�fter: <br /> Other: <br /> RECIRCULATION EOUIPMENT T e marked violations represent Health&Safety Code.,Violations and must be corrected as indicated: <br /> ❑ Filters <br /> 2' Pumps <br /> Chlorinator A AW /nn <br /> ❑ Flowmeter ccf/� �� <br /> El Gauges <br /> ✓ <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 /> El Wade Pool-2 Main Drains / w <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 k o�y -,.. O- nj / <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation <br /> WATER .QUALITYF/1 Chlorine ry p <br /> pH O J / / <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> MISCELLANEOUS <br /> ❑ Supervision& Control / /�"✓ <br /> ❑ General Sanitation / <br /> ❑ Algae <br /> Influent: <br /> Timeln: �,'aC7 `Received y: Ins c 4 d by: <br /> Effluent: � <br /> Time Out: /� •�� i � •L�- <br /> EHD 36-015-e-12 SWIMMING POOL OIR Page hof <br />