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P.aln.. SAN JOAQUIN COUNTY <br />r- -` EN` 'ONMENTAL HEALTH DEPARTNI "IT <br />1868 Ear[ Hazelton Avenue, Stockton, CA 9521,_ x232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />WIMMLNG POOL QFFICIAL INSPECTION REPOFJT <br />Name of Facility: yJ Date: �3 <br />Address: 446;ity: P Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Inspection Type: �D <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Reins" tion on or after: <br />Other: <br />RECIRCULATION E O U I P ENT <br />The marked violations represent Health & SafetyCode Violations and must be corrected as indicated: <br />❑ Filters <br />❑ Pumps <br />'OM1",/ • Q <br />�� n <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />wate,' <br />�` (AR[/ <br />E-1MainDrain Cover <br />❑ Equalizer Line Cover <br />'CONSTRUCTION `t�'°" <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />E1 Wade Pool — 2 Main Drains <br />^.SAFETY EQUIPMENT <br />Ae <br />W <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 Acid <br />❑ Clarity <br />❑ Test Kits <br />.MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: �S <br />Race' ed <br />nsp eeted by: <br />Time Out• <br />EHD 36-015-8-12 SWIMMING POOL OIR Page .1L -of A <br />