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P4�In.. SAN JOAQUIN COUNTY <br /> '1 ENI.. ONMENTAL HEALTH DEPARTN IT ru <br /> 4`• '• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 f <br /> SFO <br /> Telephone:(209)468-3420 Fax:(209)468-3877 Web:www.sigov.org/ehd p� \ <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Progra Record: VInspection Type: ""ki <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters _ <br /> ❑ Pumps VV <br /> ❑ Chlorinator w <br /> ❑ Flowmeter <br /> [I Gauges ', I' n l � <br /> E] Skimmer&Gutters �M iD <br /> ❑ Back Flow Prevention 1 a f <br /> ❑ Main Drain Cover GT <br /> ❑ Equalizer Line Coverf•� <br /> CONSTRUCTION �[ <br /> El Pool Shell n yCr` �� ar-1 <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/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:. Recei d Inspected by: <br /> Effluent: Time Out: 1 S. <br /> EHD 36-015-8-12 SWIMMING POOL OR Page_of <br />