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P.xln.. SAN JOAQUIN COUNTY <br />Y i &l 1'ONMENTAL HEALTH DEPARTI NT <br />wy <br />1868 East Hazelton Avenue, Stockton, CA 952uj-6232 <br />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: City: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Inspection 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 & SafetCode Violations and must be corrected as indicated: <br />❑ Filters <br />eo�Q <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />� <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />> �� <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />—7 r <br />❑ Wade Pool –2 Main Drains <br />-SAFETY-EQUIPMENT <br />��–/ <br />_❑ Rescue Pole <br />❑ Life Ring <br />^ /O / <br />❑ Safety Signs <br />/ 7 <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />j <br />❑ Depth Markers/files <br />f�- <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />RESTROOMS <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />/ <br />WATER QUALITY <br />- Chlorine <br />pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUS <br />Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: -" f/�"' <br />Re ei y <br />pec y: <br />�� <br />Time Out: �Q, •� <br />EHD 36-015-6-12 SWIMMING POOL OR U I Pag" <br />