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�.In. SAN JOAQUIN COUNTY vV W k <br /> EN\ ONMENTAL HEALTH DEPARTIV., AT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> I • <br /> Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: o - Fu-are Date: <br /> Address: IW'l City: Zip Code: <br /> Owner/Operator: V�. re Telephone: <br /> Program Element: 'L Program Re ord: le b,4 Inspection Type: r K4 <br /> Flow Rate(gpm): pH: 3&ap Chlorine(ppm : Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> / I Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&SafetCode Violations and must be corrected as indicated: <br /> ❑ Filters _ r},i 0 ' ';K ,J Car, t/yjr <br /> El Pumps (/ !/I .C <br /> ❑ Chlorinator <br /> ❑ Flowmeter <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover <br /> CONSTRUCTION <br /> ❑ Pool Shell \L <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 /> ❑ PooVDeck 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 /> Time In: I`j, � '� Re ived In/s�pected by: <br /> Effluent: L,!me Out: D 3 J 'lf':2-Q✓v(,//1(� <br /> EHD 36-015-8-12 SWIMMING POOL OIR Page_of <br />