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t SAN JOAQUIN COUNTY <br /> EI RONMENTAL HEALTH DEPART NT <br /> 61ju East Main Street, Stockton, CA 95202- 629 <br /> Fsyyy5 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: - S Date: I <br /> Address: $ City: 74 Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: InspectionType:U 102.6 <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> -RE C I RC U LATIION.EQ U I P ME NT c' The marked violations represent Health &Safe Code Violations and must be corrected as indicated: <br /> El Filters <br /> - c7 x <br /> ❑ Pumps cbkom <br /> ❑ Chlorinator <br /> ❑ Flowmeter <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters _ SAA41w - b <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover <br /> CONSTRUCTION <br /> ❑ Pool Shell � � ���� <br /> ❑ Fencing/Gates vf)e- It-"A � <br /> ❑ Decking &Coping <br /> ❑ Wade Pool-2 Main Drains <br /> ❑ Rescue Pole <br /> ❑ Life Ring <br /> ❑ Safety Signs <br /> ❑ Lifeguard <br /> ❑ Pool/Deck Lighting <br /> ❑ Ladders/Hand Rails Air �— <br /> ❑ Depth Markers/Tiles <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch <br /> RESTROOMSr. <br /> ❑ Showers <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation <br /> W AT E'R:-- ALITY <br /> ❑_ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> MISCELLANEOUS UV IN I WIMN <br /> ❑ Supervision & Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: Received By: ' Inspe ted by: <br /> Effluent: <br /> Time Out: V <br /> EHD 36-017-31-09 SWIMMING POOL OIR Page of <br />