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pP,.�•��N. SAN JOAQUIN COUNTY <br /> EN"IRONMENTAL HEALTH DEPART" "=NT <br /> ` '• 1868 st Hazeltop_AV6 e o�ktec� CA 95�_ -6232 <br /> �Q•.. �" Telephone:(209) 468-3420 Fax:(209) 468-3877b:www.sjgov.org/ehd <br /> /FOR <br /> SWIMMING POOL OFFICIAL INSP 'CTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Coder <br /> Owner/Operator: — Telephone: <br /> Program Element �/ Program Record: �� Inspection Type: <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 <br /> ❑ ,Chlorinator <br /> lowmeter <br /> Gauges <br /> Skimmer&Gutters <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover <br /> CONSTRUCTION <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping <br /> ❑ Wade Pool-2 Main Drains <br /> SAFETY EQUIPMENT _ <br /> ❑ Rescue Pole - <br /> ❑ •fe Ring <br /> Safety Signs <br /> ❑ Lifeguard <br /> ❑ Pool/Deck Lighting <br /> ❑ Ladders/Hand Rails <br /> Depth Markers/Tile i�111 <br /> ❑ First Aid Kits <br /> ❑ Emergency Shut-off Switch <br /> RESTROOMS <br /> ❑ Showers Q=- <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑" Chlorine - <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity _ w <br /> ❑ Test Kits r <br /> MISCELLANEOUS <br /> ❑ Supervision&Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> ' r Influent: <br /> Time <br /> Time In: Rec ived By: Fspeed by: <br /> Effluent: <br /> Time Out: <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR Page otc� <br />