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ip <br />SAN JOAQUIN COUNTY <br />ENV)NMENTAL HEALTH DEPARTM r <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3877 Web:.www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility:(!�Url r*TI•e Dater <br />Address: r-- city: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: (,Q�'�-� Program Record: Q�fj Q Inspection Type: iI! (k f <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />yanuric Acid (ppm): <br />Temp: <br />ReInspection on or after: <br />Other: <br />RECIRCULATION: EQUIPMENT;;; <br />The marked violations represent Health & Safety Code Violations and must be corrected as indicated: <br />❑ Filters <br />Ytl J J v1 <br />❑ Pumps <br />A I <br />❑ Chlorinator <br />❑ Flowmeter <br />M <br />l� <br />El Gauges <br />11 Yw yip <br />MVQ{� <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />❑ Pool Shell <br />❑ Fencing/Gates <br />❑ Decking & Coping <br />❑ Wade Pool — 2 Main Drains <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: t <br />Received By: <br />Inspected by: <br />f' y/ a, <br />> <br />Time Out: n <br />EHD 36-015-8-12 SWIMMING POOL OIR \\ U Page <br />