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n. SAN JOAQUIN COUNTY <br />EN\,.<0NMENTAL HEALTH DEPART%. JT <br />' '• 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: S( <br />City: <br />Zip Cod . 193 Z Of <br />Owner/Operator. <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type:AO2-0 <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Reinspection on or after. <br />Other <br />gRECIRCULATION EQUIPMENT-' <br />The marked Violations represent Health & Safety <br />Code Violations and must be Corrected as indicated: <br />❑ Filters <br />7 <br />441 <br />O <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />s <br />❑ Equalizer Line Cover <br />_ CONSTRUCTION <br />❑ Pool Shell <br />T��d2� <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 />❑ Pool/Deck Lighting <br />❑ Ladders/Hand Rails <br />❑ Depth Markers/riles <br />❑ First Aid Kits <br />❑ Emergency Shut-off Switch <br />- - - REST.. -_ <br />Ilk <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />- WATER QUALITY <br />❑ Chlorine <br />❑ pH — <br />❑ Cyanuric Acid <` <br />❑ Clarity <br />❑ Test Kits <br />i. ..MISCELLANEOUS <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In: <br />Rece By: <br />Gn p <br />ted by: <br />Time Out: <br />EHO 36-017-31-09 SWIMMING POOL OR v Page 1 of j— <br />