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EHD Program Facility Records by Street Name
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3600 - Recreational Health Program
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PR0360479
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COMPLIANCE INFO
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Last modified
8/31/2021 4:06:09 PM
Creation date
8/31/2021 3:59:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3600 - Recreational Health Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0360479
PE
3612
FACILITY_ID
FA0000887
FACILITY_NAME
MERITAGE APARTMENTS
STREET_NUMBER
2440
Direction
W
STREET_NAME
TURNER
STREET_TYPE
RD
City
LODI
Zip
95242
APN
02917013
CURRENT_STATUS
01
SITE_LOCATION
2440 W TURNER RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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APPROVED ey. California Department of Public Health OFFICE USE ONLY <br />Compliance Form <br />Anti -Entrapment Devices and Systems <br />oATE: for Public Pools and Spas <br />Health and Safety Code Sections 116064.1 and 116064.2 <br />NOTE: Use one form for each pump or multiple pumps under the same drain cover. <br />ALL SECTIONS OF THIS FORM MUST BE COMPLETED. <br />This form is to be used to verify compliance with modifications pursuant to the new Health and Safety Code sections 116064.1 and <br />116064.2. Under Section 116064.2 (a) of the Health and Safety Code, effective January 1, 2010, the owner of a public swimming pool <br />shall file this form within 30 days following the completion of construction or installation of anti -entrapment devices or systems in <br />swimming pools. Contact your local Environmental Health Department and Building Department for any necessary plan approval and <br />permits prior to construction or remodel. <br />Site Information <br />Facility Name: AN's+A4P Pool Identification (if more than 1 pool/spa <br />Facility Address: 2c/4& — /.1JE57—T,?i7 e'2- city. 6oi.,, St: <br />Owner Name: _ <br />Owners Address <br />Pool constructed on or after January 1, 2010?: o Yes <br />Owner's Phone Number <br />Zip <br />-Recirculation Pump o Jet! Booster Pump <br />Make/Model H. P Make/Model H <br />❑ Other Pump: o Feature Pump <br />Make/Model HP Make/Model H.P <br />Main Drain Includes All Suction Outlets Exce t Skimmer E uahzer Lines �" _ <br />Mam,facturer of approved drain cover: Model Number!{ W �2Crl� Install date O <br />GPM rating: Floor i7lj Wall Installed on loor o Wail <br />Manufacturer of approved drain cover: Model Number. Install date <br />QPM ratingFloor Wall installed on o Floor o Wall Main drain/Jet suction pipe size is inches. <br />:heck One <br />pit; main drain(s) (Minimum 3 If between covers, hydraulically balanced and symmetrically plumbed) <br />Single drain — Unbiockable (size and shape that a human body cannot sufficiently block to create a suction entrapment) <br />r_ Single drain — Not unblockable (one of the following secondary devices required: safety vacuum release system, suction limiting vent <br />system, gravity drainage system, auto pump shut-off system, or other equally or more effective system approved by enforcement agency) <br />Type of secondary device installed: Install date <br />Manufacturer of approved device: Model/Part Number. . <br />Safety vacuum release system bears the following performance standard markings: o ATSM F2387 O ASME/ANSI standard A 112.19.17 <br />Skimmer Equalizer Lines) <br />lanufacturer of approved suction fitting: _ j4i:6 CIA S—ii Model Number: 4 !O 2er`cL Install date /0 (1 <br />:PM rating. GPM rating: Floor Wall Installed on o Floor all <br />kimmer equalizer line(s) pipe size were found to be Z rr inches Number of Skimmers: 7 — <br />THE ABOVE HAS BEEN FIELD VERIFIED TOC MPLY TH MA FACT ER'S IN AL ION REQUIREMENTS BY THE INSTALLER <br />leclare that I hold an active Califomia State Contractor license # with classification C_ —3 or a California State <br />ofessional Engineer license # with qualified experience working on public swimming pools and that the information <br />ovided above is true to the best of my knowledge. I understand that if I improperly certify this information. I shall be subject to potential <br />;mplinary action at the discretion of the licensing authority in accordance with California Health 8 Safety Code Section 116064.2. <br />mpany Address:hiLLPt—LIv9e, to V <br />r _A�I�SM}�uh'['y State: O Zip Code: 2 / <br />,tractor/Engineer Phone Number: 91(O — 3 18 —ZUoo _ Cell Phone Number: /�'� — 997-671'7 <br />rtractor/Engineer FAX Number: { — 8 — .O® Erl W dPQ!Jei—:... r— <br />AiL <br />$ 0 e oyfli / zo<LY <br />Contractor / Engineer name (PRINT) c,omilacior r 69fifinder name (SIGNATU)4 to <br />a complete text of the law, visit. http:l/info.sen.ca.gov/pub/09-10/bill/a /a6 1001-1050/ab_1020 bill 20091011 chaptered.pdf <br />Rirvii Jury 14, 2010 <br />
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