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SAN JOAQUIN COUNTY <br />�p4 rOG <br />?� ENV IRONMENTAL HEALTH DEPARTNu NT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />qCi FiiaN <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address: City: Zip Code: 5 Sf <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Inspection Type: <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm):Cyanuric <br />7 <br />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 />n <br />❑ Pumps <br />a <br />❑ Chlorinator <br />❑ Flowmeter <br />U <br />❑ Gauges <br />r _ <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />—b-e.� <br />❑ Main Drain Cover <br />r <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />❑ Pool Shell <br />❑ Fencing/GatesAd <br />❑ Decking & Coping <br />❑ Wade Pool — 2 Main Drains <br />SAFETY EQUIPMENT <br />ADa•� • <br />❑ Rescue Pole <br />/f (CrtC - 0 <br />�(i(�t..00 <br />E] Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />•. W <br />❑ PoollDeck Lighting <br />❑ Ladders/Hand Rails <br />It e <br />❑ Depth Markers/Tiles <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />Air <br />^ Q _ /1 - <br />a LE(AY/LOI� AA44,L UJ <br />RESTROOMS <br />�r <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />r <br />WATER QUALITY <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUSA70 <br />&a a WX Q <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: <br />R eived : <br />/ �`� <br />Inspected by: <br />Vij4t" <br />Time Out: <br />EHD 36-0105-29-2007 ---0,"— Page L of <br />