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SAN JOAQUIN COUNTYAg <br /> \ <br /> ' Er 'RONMENTAL HEALTH DEPART ' —NT <br /> 1868 =ast Hazekon-Avenue, Stockton, CA 95 ,,6-6232 <br /> .[e hone: 209 468-3420 Fax: 209) 468-3877 Web:www.s ov.or /ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPOR'i <br /> �.,� <br /> Name of Facility: / Date: Ubqj, <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: p <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: VReinspection on or after: <br /> Other: <br /> IRE ClRCUCATIONlEt7ulPitihENTIThe marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ElFilters ++ <br /> El Pumps �b l nlA r n YZtc.ti <br /> ❑ Chlorinator I vlKK44LAIX UUZti2. raIn& 0 SkAS <br /> ❑ Flowmeter lar a /� 0 uS. � fide. <br /> El Gauges <br /> ❑ Skimmer&Gutters /2R ,Q Y- ¢� <br /> ❑ Back Flow Prevention Vc <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover A <br /> CONSTRUCTION� we <br /> Q <br /> E] Pool Shell � �p <br /> ❑ Fencing/Gates �� Cy -fes ►MI►OWh <br /> ❑ Decking&Coping ,,Q <br /> ❑ Wade Pool-2 Main Drains <br /> fISSAFETYJEOUIPMENT, ,(l <br /> ❑ Rescue Pole �I <br /> ❑ Life Ring <br /> ❑ Safety Signs <br /> ❑ Lifeguard �+ <br /> r ❑ Pool/Deck Lighting 5 1 mat <br /> ❑ Ladders/Hand Rails icC1h —„p <br /> r ❑ Depth Markers/Tiles 1 <br /> ❑ First Aid Kits y <br /> i ❑ Emergency Shut-off Switch <br /> RESTROOMS� <br /> ❑ Showers �j o,d t,t,e Ako-10/,, <br /> ` ❑ Toilet&Dressing IV <br /> ❑ Ventilation <br /> WATER IOU ' <br /> ❑ Chlorine .� <br /> ❑ pH hQ,th- <br /> ❑ Cyanuric Acid19 InfA <br /> {s � <br /> ❑ Clarity <br /> ❑ Test Kits at�g, lam-' <br /> �MISCELL'ANEOUS� <br /> ❑ Supervision&Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: —_ R ceiv MedEffluent: Time Out: ou -b 33J <br /> EHD 36-015-8-12 SWIMMING POOL OIR Page-01 <br /> �� v <br />