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e In. SAN JOAQUIN COUNTY <br />EM JNMENTAL HEALTH DEPARTIV T <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 468-3877 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />f <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />_ <br />Progr 36 Program Record: <br />Inspe tion Type: <br />Flo Rafe (gpm): <br />i <br />� hloodne (ppm): <br />v'V r- C <br />yanuric Acid (ppm): <br />Temp: O a <br />Reinspection on or after: <br />Other: <br />EII.tR C'G CATION EQUIPMENT- <br />The marked violations represent Health & Safety <br />Code Violations and must be corrected as indicated: <br />❑ Filters <br />.Q . <br />?-Z' v <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />2 <br />0, <br />/ <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />e <br />�/ <br />W <br />❑ Equalizer Line Cover <br />CONSTRUCTION <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />❑ Wade Pool — 2 Main Drains <br />SAFETYEQUIPMENT <br />❑ Rescue Pole <br />❑ Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />❑ Depth Markers riles <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />_ RESTROOMS <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />- WATER QUALITY <br />❑ Chlorine <br />0 WH <br />El Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />r <br />� <br />r <br />�V <br />`^ ..�f11 <br />Influent: V p t <br />I <br />1111 ` <br />Effluent: 2 <br />_ <br />Q,/h- <br />Timeln: ` Q <br />Reeei ed By:nape <br />ted by: <br />9— _ d 3 <br />Time Out g� <br />EHD 36-01 5-8-12 SWIMMING POOL OR Page —1Lof Zk <br />