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SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SWIMMING POOL SURVEY FORM <br />Date of Survey. / • <br />BUSINESS NAME and ADDRESS: , Of Co a o <br />POOL OWNER and ADDRESS: <br /> <br />( • 71r ox-z,v <br /> <br />I. PHYSICAL PLANT PHONE NO. <br /> <br />Age of Pool: /7 years <br />Type of Pool: Recirculating, Fill and draw, <br /> Combination Recirculating and Fill and Draw. <br />Size of Pool: Length,7‘ Width, _3 Shallow End <br />Depth, Deep End Depth/ 4c, 'Gallons Capacity. <br />i. fi te Filtration/ 1- <br />Type of Filter: Sand, Diatomaceous Earth, <br /> Automatic slurry-fed, Diatomaceous Earth, <br /> Other. <br />No. of Filters: , Size (1 , Make and Model <br />Nos. . Capacity in gals/min/sq.ft. of surface <br />area <br />Input pressure gauge reading: before backwash, <br /> after backwash. <br />Outlet pressure gauge reading: before backwash, <br /> after backwash. <br />Pump size: h.p., Pump capacitY: G.P.M., <br /> <br />Turnover rate: hrs. <br />Skimming device: scum gutter, skimmers <br />CHLORINATOR: gas liquid, hand, other <br />POOL APfROACH: concrete, lawn, sand, <br /> other (specify) <br />FENCE: <br /> <br />height, self closing gate yes or o) <br />pool completely enclosed (yes or <br /> <br />EH No. 15 (a)