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„a4Nr� SAN JOAQUIN COUNTY EN1 ONMENTAL HEALTH DEPARTK IT 1868 East Hazelton Avenue, Stockton, CA 95200-6232 •-Fo Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd SWIMMING POOL OFFICIAL INSPECTION REPORT Name of Facility: PCOVC4 Date: to _ Address: City: _TAALY Zip Code: Owner/Operator: Telephone: Program Element: Program Record: Inspection Type: Qt ' "17� Flow Rate (gpm): pH: Chlorine (ppm): Cyanuric Acid (ppm): Temp: Other: Reinspection on or after: MAJ = Major Violation OUT = Not in Compliance COS = Corrected on-site See reverse side for code sections and general requirements that correspond to each violation listed below. Items listed on this report as violations do not meet the requirements set forth in the California Health and Safety Code section(s) 116043, 116040, & 116050. All violations must be corrected within specified timeframe. Violations that are classified as "MAJOR” pose an immediate threat to public health and must be corrected immediately Orbe subject to closure pursuant to California Code of Regulations (Title 22) section 65545. VIOLATION MAJ OUT COS VIOLATION MAJ OUT COS-' 1 Pool Gates ❑ ❑ ❑ 35 Flow Meters ❑ ❑ 2 Pool Enclosure ❑ ❑ ❑ 36 Pressure and Vacuum Gauges ❑ ❑ 3 Safety Signs ❑ ❑ 37 Electrical Hazards ❑ ❑ ❑ 4 Safety Equipment E] E] E]38 Filter Cleaning and Maintenance El❑ 5 Restrooms and Showers El El39 Wastewater Disposal ❑ ❑ 6 Hose Bibb Anti Siphon Device ❑ ❑ 40 Spray Ground UV Disinfection ❑ ❑ ❑ 7 Pool Deck ❑ ❑ 41 Spray Ground Pumps Interconnected ❑ I ❑ ❑ 8 Pool Deck and Lighting ❑ ❑ 42 Spray Ground Recirculation System ❑ ❑ ❑ 9 Ladders and Handrails ❑ ❑ 43 EHD Approval Required ❑ ❑ ❑ 10 Disinfectant Residual ❑ ❑ ❑ 44 Lifeguard Certification ❑ ❑ 11 Combined Chlorine Concentration ❑ ❑ 45 Lifeguard First Aid Equipment ❑ ❑ 12 pH Level ❑ ❑ ❑ 999 Other ❑ ❑ ❑ 13 Cyanuric Acid Concentration ❑ ❑ ❑ 1 611 4 ( I 14 Chemical Water Test Kit ❑ ❑ 15 Operation Records ❑ ❑ OJ1-1 C{5 u5 4� 'AI -V / 16 Water Clarity ❑ ❑ ❑ re rA r MKM f S. IcM' -a 16 O ^Ca ER 17 Cleanliness of Pool ❑ ❑ 18 Pool Shell and Tile ❑ ❑ A44n4ce beiwc4n gplrf Civ ers 19 Depth Markers ❑ ❑ 20 Depth Marking Line ❑ ❑ (� ;J4 Cl f TfKC R 21 Water Level EI El©V 22 Skimmer Assembly ❑ ❑ fl 1ti I TG 23 Pool Inlets and Outlets ❑ ❑ S 24 VGB Suction Covers ❑ ❑ ❑ 25 Spa Emergency Shut Off Switch ❑ ❑ ❑ At( ( W o-rIZ 56ipi � a Pee 0 (6L u s . 26 Spa Operating Temperature ❑ ❑ ❑ ®Ie d 27 Pool Equipment Room 11 El 28 Safety Vacuum Release System ❑ ❑ ❑ 29 Recirculation System Operation ❑ ❑ ❑ 30 Pool Equipment & Plumbing Maintained 1 ❑ ❑ C t Irl4'Q'$ ove 4(0'(0J 31 Disinfectant Feeders❑ ❑ ❑ 32 Chemical Control and Monitoring System ❑ ❑ 33 Minimum Turnover Time ❑ ❑ 34 Maximum Flow Rate ❑ ❑ ALL EHD STAFF TIME ASSOCIATED WITH BRINGING THIS FACILITY INTO COMPLIANCE, INCLUDING REINSPECTIONS, WILL BE BILLED AT THE CURRENT HOURLY RATE, Time In: Time Out: Received By: e_ Inspect EHD 36-01 Rev. 08/08/16 Page 1 of SWIMMING POOL OIR