COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SEP -09-2014 10:12 From:BurkBtts 2095453848 To 12094640138 Paget/2 JOB: 70146-2014 APPROVED BY: DATE: c. �1 California DefSaHment of Public Health Cgmpllance Form Anti -Entrapment Devices and Systems for Public Pools and Spas Health and Safety Code Sections 116064.1 and 116064.2 O FCF,� I CF 1_E NOTE: Use.:. one form for each pump or multiple Dumps under the same drain cover. ALL SECTIONS OF THIS FORM MUST Be COMPLETED. This form Is to be used to verity compliance with modification pursuant to the now Health and Safety Code sections 116064.1 and 116064.2. Under Section 116084.2 (a) of the Health and Safety Code, effective January 1, 2010, the owner of a public swimming pool shall file this form whhln 30 days following the completion of construction or Installation of anti -entrapment devices or systems In swimming pools. Contact your local Environmental Health Department and Building Department for any necessary plan approval and permits prior to construction or remodel. AMclnfofmaHMFairfield Inn Pool Facility Name: Pool Identification (if more than 7 poouspa at site). Facility Address: 2410 Naglee Rd. City: Tracy Sh r©_Zip: 95304 Owner Name: Owner's Phone Number: 209833-0135 Owners Address City St. _ zip Pool constructed on or after January 1, 20107: n Yes ■ No Pum Info 11 ReclroulationPump et/Booster Pump aka/ModelHayward H.P.2 ake/Model H.P nOther Pump: ❑Feature Pump MMake/Model. -H.P- Make/Modal_.__- J�•P Main Drain (Includes. All Sucdon Outlets Ermept Skimmer Eauatlzer LinW A10RCFR101 8.21-14 Manufacturer of approved drain cover: Aqua' Star10" Rd-sumpless del Numoer. Install date GPM rating: Floor 170 Wall Installed onloor ❑ Wall Manufacturer of approved druln cover: _ Model Number. Install date GPM rating: Floor Well Installed onDloor ❑ Wall Main drain/Jet suction pipe size Is 2.5 inches. Check One: © Split main drain(s) (Minimum 3 ft between covers, hydraulically balanced and symmetrically plumbed) Single drain - Unblockable (size and shape that a human body cannot sufficiently block to create a suction entrapment) ❑Single drain - Not unblockable (one of the following secondary devices required: safety vacuum release system, suction limiting vent system, gravity drainage system, auto pump shut-off system, or other equally or more effective system approved by enforcement agency) Type of secondary device installed:, Install date Manufacturer of approved device: -- - ...... ._-_-.. - ModeVPart Number. Safety vacuum release system bears the following performance standard markings: D ATSM F2387 ❑ ASME/ANSI standard A 112.19.17 S§klmmer"uallzerLina(s) Aqua Star 10" round/ sui A10RCFR101 8.21.14 Manufacturer of approved suction fitting: I Model Number: Install date GPM rating: GPM rating: Floor 170 - Was 164 Installed on door �I✓_ Wall Skimmer equalizer llne(s) pipe size were found to be 2 inches Number of Skimmers: 2 1 declare that I hold an ac ve California Professlonal Engineer license provided above is true to the best of my disclolinary action at the discretion of th� Contractor license # 608182 with classification C53 or a California State with qualified experience working on public swimming pools and that the information ledge. I understand that if I improperly certify this Information. I shall be subject to potential isina authority in accordance with California Health $ Safety Code Section 116064.2. Contractor/Engineer Name: Robert R. Burkett Company Name: RurketPa Pool Plastering, Inc. Company Address: P.O. Box 938 City: $elide State: Ca 7ip code: 95368 Contractor/Engineer Phone Number: 209 599.3317 Cell Phone Number. Contractor/Engineer FAX Number. 209 Robert R. Burkett Contractor / Engineer name (PR For a complete text of the law, visit hM name 9-4-14 Date Received Time Sep. 9. 2014: 10:14AM Nc.7007 AodcoaW"Iy 14, 2010