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/ aPo0"" SAN JOAQUIN COUNTY <br /> ¢2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 304 East Weber Avenue, 3 d Floor, Stockton,CA 95202-2708 <br /> \ <br /> \`� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> c � P <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: ,( �S City: Ltg f Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps 16 A_ S K,G pYI II <br /> ❑ Chlorinator W I� <br /> ❑ Flowmeter <br /> ❑ Gauges Ver /r <br /> ❑ Skimmer&Gutters I l �- <br /> a <br /> ❑ Back Flow Prevention / <br /> ❑ Main Drain Cover �t✓'hd k� 0.- H� <br /> ❑ Equalizer Line Cover 'r�i h 4 K N G lL <br /> CONSTRUCTION <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping LL <br /> ❑ <br /> Wade Pool—2 Main Drains 10.4 <br /> d W�cW <br /> SAFETY EQUIPMENT 0� w D(� <br /> ❑ Rescue Pole L ,' `_ <br /> ❑ Life Ring 1w 1 4u* _ <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 /> Time In; Received By: I ape ted by: <br /> Effluent: Time Out: <br /> EHD 36-01 5/26/05 Page_of <br />