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n ..1„.. SAN JOAQUIN COUNTY <br />” Er IONMENTAL HEALTH DEPARTP -NT <br />".ilYa <br />1868 East Hazelton Avenue, Stockton, CA 952__-6232 ,, / <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd 4/ 6- <br />SWIMMING POOL OFFICIAL INSPECTION REPORT . <br />Name of Facility: Date: / <br />Address: <br />mo City:J&Wk <br />11PAIAZip Code: 7 E <br />Owner/Operator:Of <br />elephcne: a <br />Program Element: Program Record: Inspection Type: <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Rein pection on or after: <br />Other: <br />RECIRCULATION. EQUIPMENT <br />The marked violations represent Health & SafetyCode Violations and must be corrected as indicated: <br />❑ Filters <br />.r <br />NQS O <br />❑ Pumps <br />I (/ <br />❑ Chlorinator <br />❑ Flowmeter <br />a f <br />❑ Gauges <br />a t Get <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />-.+ <br />❑ Wade Pool -2 Main Drains�UV <br />SAFETY EQUIPMENT' <br />❑ Rescue Pole <br />n <br />An <br />wat <br />❑ Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />/�N <br />V <br />E] Depth Markers/Tiles <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />`• ' a <br />W <br />-RESTROOMS <br />E] Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />..:...WATER QUALITY <br />❑ Chlorine <br />❑ Cyanuric Acid <br />MAW QKeALA,.d ` <br />to datcam <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: <br />Rec_ejved y: <br />�/�/� <br />I• spec ed by: <br />�r <br />Time Out: I l� <br />EHD 36-01 5-6-12 SWIMMING POOL OIR <br />Page J-- ILL, <br />