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- PUBLIC HEALTH SERVItES ..• (VAN. <br />;Ii.'pg c5.4.4\ <br />SAN JOAQUIN COUNTY w .r.• <br />ENVIRONMENTAL HEALTH DIVISION <br />In: <br />Karen Furst, M.D., M.P.H., Health Officer <br />304 East Weber Avenue, Third Floor • Stockton, CA 95202 <br /> ark•g".;:.. <br />209/468-3420 <br />VERIFICATION OF COMPLIANCE WITH CALIFORNIA HEALTH AND <br />SAFETY CODE, SECTION 116049.1 (a-f) <br />Site address of pool(s) IC) 1 So 11() ArAit L-03 <br />City a) CI I tqc,CCre <br />Number of swimming pools, spa pools, wading pools or special purpose pools at the site <br />, tpoo <br />I verify that I am the owner/home owner association president/legally responsible person for the <br />above named pool(s) and that I had the pool(s) inspected for compliance with Section 116049.1 <br />(a-t) of the California Health and Safety Code. <br />Print name ilmath,c3 r ( ale\ of Date E-3 1 \ C;\ <br />Signature <br />Address 93 C-- 1100 (.1 <br />Cit&A/e f-D St CC:A Zip <br />Telephone ( 1(.0 ) S(09-- Is4-c) <br />[I] There is no pool light in this/these pool(s). Indicating there is no pool light means there <br />is no light fixture, light casing, or recessed light niche, whether working or not <br />working, within the confines of the pool shell. <br />Please attach a copy of the completed and signed inspection permit or report from the local <br />building department and send to: San Joaquin County <br />Public Health Services <br />Environmental Health Division <br />Recreational Health Program <br />304 East Weber Avenue, Third Floor <br />Stockton, CA 95202