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oP4�ln, SAN JOAQUIN COUNTY <br /> EN\ ONMENTAL HEALTH DEPARTA IT <br /> �O 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �gIDV Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov,org/ehd <br /> F00.� ll <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: V City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: - <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: V Reinspec' n on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT>- a marked VIOIatIOnS re res t Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps — <br /> ❑ Chlorinator <br /> ❑ Flowmeter J <br /> ❑ Gauges � A <br /> ❑ Skimmer&Gutters z AL <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover nLee ' " <br /> CONSTRUCTION <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping <br /> ❑ Wade Pool—2 Main Drains <br /> SAFETY EQUIPMENT <br /> ❑ Rescue Pole <br /> ❑ Life Ring <br /> ❑ Safety Signs <br /> ❑ Lifeguard <br /> ❑ POoUDeck Lighting ` -tog— A4'k id <br /> ❑ Ladders/Hand Rails <br /> ❑ Depth Markers[Tiles <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch /q , <br /> RESTROOMS (J <br /> ❑ Showers <br /> ❑ Toilet&Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> MISCELLANEOUS O r <br /> ❑ Supervision& Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: i Received- Insp'�e/�,cted by: <br /> Effluent: Time Out: <br /> EHD 36-01 5-8-12 SWIMMING POOL OR Page J—of 1 <br />