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a. SAN JOAQUIN COUNTY <br /> r y Ery" -10NMENTAL HEALTH DEPART -NT <br /> - 1868 Last Hazelton Avenue, Stockton, CA 9520-6232 <br /> Telephone:(209)468-3420 Fax:(209) 468-3877 Web:www.sigov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: / -r 1g Date: <br /> Address: City: Zip Code: �33 <br /> Owner/Operator: Telephone: <br /> Program Element: a Program Record: Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine( Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> F� ,?. 8 <br /> Other: <br /> RECIRCULATION EQUIPMENT 4'- The marked violations represent Health&SafetCode Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps <br /> ❑ Chlorinator <br /> ❑ Flowmeter <br /> E-1Gauges 4!5?— ` <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover p�( <br /> CONSTRUCTION <br /> ❑ Pool Shell _ <br /> ❑ Fencing/Gates /'-00 dr <br /> ❑ Decking&Coping <br /> ❑ Wade Pool-2 Maii Drains <br /> SAFETY EQUIPMENT <br /> ❑ Rescue Pole t V <br /> ❑ Life Ring �J <br /> ❑ Safety Signs P ' <br /> L] Lifeguard 67�' , 461Z^/ <br /> ❑ Pool/Deck Lighting C <br /> ❑ Ladders/Hand Rails <br /> ❑ Depth Markersfriles <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch <br /> ❑ Showers <br /> ❑ Toilet&Dressing <br /> ❑ Ventilation <br /> ❑ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> MISCELLANEOUS <br /> _[1 Supervision & Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Timeln: <br /> i <br /> Effluent: <br /> Time Out:,�� <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR Page�of� <br />