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Ppkl SAN JOAQUIN COUNTY - <br />r` ENbr,iONMENTAL HEALTH DEPARTN,�AT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />p.. <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: Q Date: / <br />Address: City: Zip Code: <br />Owner/Operator: elephone: <br />Program Element: - Program Record: I spection Type: <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Reinspection 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 MarkersfTlIes <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />❑ Chlorine <br />❑ pH <br />_ <br />❑ Cyanuric Acid <br />❑ Clarity <br />"• ' <br />❑ Test Kits <br />- - <br />_-_:.--MISCELLANEOUS <br />❑ Supervision &Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: <br />Received By:Inspe <br />ted by: <br />�I <br />Time Out: (� ;� <br />EHD 36-01 5-8-12 SWIMMING POOL OIR Page I of j— <br />