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raNl SAN JOAQUIN COUNTY <br /> E •IRONMENTAL HEALTH DEPAR- ENT <br /> Poi ! <br /> 186b mast Hazelton Avenue, Stockton, CA 96�j5-6232 <br /> ;Fa 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: yLem"--74 City: S4o hZip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Q 3 Z 6 Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Rii-rkpection on or after: <br /> -14P G-1/ Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps <br /> ❑ Chlorinator <br /> ❑ Flowmeter / <br /> ElGauges rlt n /G/_ <br /> El Skimmer&Gutters (j1 r� c �-K 4 <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ J-7 OL- <br /> Equaltzei Line Cover <br /> CONSTRUCTION <br /> ❑_ Pool Shell _ <br /> ❑ Fencing/Gates <br /> ❑ Decking& Coping <br /> ❑ Wade Pool-2 Main Drains n -C.� O r <br /> SAFETY EQUIPMENT /_&o � �'� <br /> ❑ Rescue Pole - !/ <br /> ❑ Life Ring <br /> ❑ Safety Signs /'S ( wzi r C7�oi�S <br /> ❑ Lifeguard <br /> ❑ Pool/Deck Lighting V4 <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 /> Time In: 1-,16 Rec vad By: Unspected by: / <br /> Effluent: <br /> Time Out:,/! J 7 <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR Page of <br />