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SWIMMING POOL SURVEY FORM - Page 2 <br />II. SOURCE OF WATER <br />City water supply , well , other <br />III. POOL OPERATION <br />Supervision: lifeguard, attendant <br />Chemical Treatment <br />1. Alum: lbs. per month <br />Soda Ash: lbs. per week <br />Acid: gallons per month <br />Algicide: type used <br /> <br />frequency of use <br /> <br />Hyper Chlorination: type (gas or Hypochlorite) <br />frequency of hyperchlorination <br />Disinfection: <br />other <br /> <br />chlorine type, iodine type <br /> <br />, quantity used per day <br /> <br />Cleaning Procedure: <br />Vacuum cleaning: times per week <br />Filter backwashing: c__ ,,,(Ki• times per month <br />Pool apron cleaned: ((&,)c times per week, method of <br />cleaning <br />Tile cleaned: times per month, cleaning agent <br />Pool strainer cleaned: times per week <br />Test kit used: times per week <br />Safety Provisions: first aid kit, body hook, <br />life preserver, underwater lighting <br />IV. POOL PLAN - Sketch plan locating the following: inlets, skimmers, <br />fill line, vacuum filtings, filters, changing rooms, toilets, <br />urinals, and sewer lines or leach lines. <br />EH No. 15 (b)