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Qtt.".�c SAN JOAQUIN COUNTY <br />I j 1" „.\ EN ,IRONMENTAL HEALTH DEPAR" =NT <br />f 1868 East Hazelton Avenue, Stockton, CA 95zu5-6232 <br />;zaR 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: l( --L � City: Zip Code: <br />Owner/Operator: 9,I V'C't Telephone: j- "SI 51 <br />Program Element: R�i Program Record: S Inspection Type: 41G'1;1�+1L <br />Flow Rate (gpm): <br />�V <br />pH: <br />/ - <br />1 <br />Chlorine (p�� <br />^II77`r <br />,2 <br />0,c <br />Cyaguriic cid (ppm): <br />/lT �t'lGh <br />30 <br />Temp: / „ <br />ll� <br />Reinspection on or after: <br />Other: <br />RECIRCULATION EQUIPMENT <br />The marked violations represent Health & SafetCode 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 />' A4NSTRUCTION'' <br />- <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 />- -- -- - <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />- <br />WATER QUALITY <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />SCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: / ]� <br />l V <br />Effluent: <br />Time In: (�1 ra <br />Received By: <br />Inspected by: <br />Time Out: <br />EHD 36-01 5-8-12 SWIMMING POOL OIR Page — of <br />