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SAN JOAQUIN COUNTY <br /> ENV )NMENTAL HEALTH DEPARTM T <br /> \� 1868 East Hazelton Avenue, Stockton, CA 9520b-0232 <br /> Telephone: (209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C, Date: <br /> Address: A-le kA City: Cftm Zip Code: AJ 24 0,1 <br /> Owner/Operator `Q �} Telephone: � t O1— 5- <br /> Program Element:3611 /3612 Program Record: 03 10InspectionType: Fo 'k.p— <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid Temp: Other: Reinspection on or after: <br /> P 100 bpm P $'� P I S PIHpm): <br /> 0 I. � X30 <br /> MAJ=Major Violation OUT=Not in Compliance COS=Corrected on-site <br /> 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 <br /> meet the requirements set forth in the California Health and Safety Code section(s) 116043, 116040,&116050. All violations must be corrected within <br /> specified timeframe. Violations that are classified as"MAJOR"pose an immediate threat to public health and must be corrected immediately or be subject to <br /> closure pursuant to California Code of Regulations(Title 22)section 65545. <br /> VIOLATION -MAJ-- OUT COS VIOLATION MAJ OUT COS <br /> 1 Pool Gates ❑ ❑ ❑ 35 Flow Meters 7SF ❑ <br /> 2 Pool Enclosure ❑ ❑ ❑ 36 Pressure and Vacuum Gauges ❑ ❑ <br /> 3 Safety Signs ❑ ❑ 37 Electrical Hazards ❑ ❑ ❑ <br /> 4 Safety Equipment ❑ ❑ ❑ 38 Filter Cleaning and Maintenance ❑ ❑ <br /> 5 Restrooms and Showers ❑ ❑ 39 Wastewater Disposal ❑ ❑ <br /> 6 Hose Bibb Anti Siphon Device ❑ ❑ 40 Spray Ground UV Disinfection ❑ ❑ ❑ <br /> 7 Pool Deck ❑ ❑ 41 Spray Ground Pumps Interconnected ❑ ❑ ❑ <br /> 8 Pool Deck and Lighting ❑ ❑ 42 Spray Ground Recirculation System ❑ ❑ ❑ <br /> 9 Ladders and Handrails ❑ ❑ 43 EHD Approval Required ❑ ❑ ❑ <br /> 10 Disinfectant Residual 44 Lifeguard Certification ❑ ❑ <br /> 11 Combined Chlorine Concentration ❑ ❑ 45 Lifeguard First Aid Equipment ❑ ❑ <br /> 12 pH Level ❑ 999 Other ❑ ❑ ❑ <br /> 13 Cyanuric Acid Concentration ❑ ❑ ❑ <br /> 14 Chemical Water Test Kit ❑ ❑ ; ` 3 • Mm(K <br /> 15 Operation Records ❑ ❑ hertiece!, '2_10 <br /> 16 Water Clarity ❑ ❑ ❑ <br /> 17 Cleanliness of Pool ❑ ❑ f ,./ <br /> 18 Pool Shell and Tile ❑ ❑ Z !4+ teVej (:�!I <br /> 19 Depth Markers ❑ ❑ <br /> 20 Depth Marking Line ❑ ❑ <br /> 21 Water Level E01 El lNz (4 ape i for <br /> 22 Skimmer Assembly % ❑ 0) o- id <br /> 23 Pool Inlets and Outlets L1 ❑ 1. !' <br /> 24 VGB Suction Covers El ❑ 4J "I '< Tor <br /> 25 Spa Emergency Shut Off Switch El L1 ❑ l O <br /> w nteter, <br /> 26 Spa Operating Temperature El El ❑ <br /> 27 Pool Equipment Room ❑ ❑ <br /> 28 Safety Vacuum Release System ❑ ❑ ❑ #Ve: <br /> 29 Recirculation System Operation ❑ ❑ ❑ <br /> 30 Pool Equipment&Plumbing Maintained E] E] C 0 CL <br /> 31 Disinfectant Feeders ❑ ❑ ❑ <br /> 32 Chemical Control and Monitoring System ❑ ❑ -f Nuj0 <br /> 33 Minimum Turnover Time ❑ ❑ <br /> 34 Maximum Flow Rate ❑ ❑ <br /> ALL EHD STAFF TIME ASSOCIATED WITH BRINTHIS FACILITY INTO COMPLIANCE,INCLUDING REINSPECTIONS,WILL BE BILLED AT THE CURRENT HOURLY RATE. <br /> Time In: Time Out: Recti B Insp ed <br /> EHD 36-01 Rev.08/08/16 1/_QI /rJ S'�[Q�'id .� Page 1 cf SWIMMING POOL OIR <br />