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aPay.In. SAN JOAQUIN COUNTY <br />w < <br />EM DINMENTAL HEALTH DEPARTN T <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Fo Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: •� G- City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />Flow Rate (gpm): <br />pH: <br />�y <br />Chlorine (ppm): <br />�``�• ? <br />Cyanuric Acid (ppm): <br />�j?Jm <br />Temp: <br />Relt1spection 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 />/ Q <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />j <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />�'• <br />/ <br />❑ Pool Shell <br />_ <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />❑ Wade Pool -2 Main Drains <br />SAFETY EQUIPMENT- <br />/ <br />' <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 />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />WATER QUALITY <br />❑ Chlorine _ <br />❑ pH <br />❑ Cyanuric AcidJE <br />Clarity <br />❑ Test KitsMISCELLAN❑ <br />Supervision & C❑ <br />General Sanitat❑ <br />Algae <br />Influent:e- <br />Effluent: <br />�• <br />/l•,fxQ <br />Timeln: /a qO <br />e d y: Insp <br />ed by: ' <br />�-- <br />Time Out: /,/� <br />EHD 36-01 5-8-12 SWIMMING POOL OIR `� U I Page _zof / <br />Hr% <br />