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A SAN JOAQUIN COUNTY <br /> & RONMENTAL HEALTH DEPART NT <br /> Y. 600 East Main Street, Stockton, CA 95202-3029 <br /> F � Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� Date: _ —1-2 <br /> Address: City: Zip Code: <br /> Owner/Operator: d r0 Telephone: <br /> Program Element: Program Record: Inspection Type: — S <br /> Flow Rate(gpm): pH: Chlorine rm% <br /> Cyanuric Acid(ppm): Temp: Reinsp tion on or after: <br /> � Other: <br /> RECIRCULATION EQUIPMENT:, The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> tFilters <br /> umps <br /> hlorinator ce <br /> Flowmeter <br /> Gauges <br /> Er Skimmer&Gutters p�j` �O .�) 173 <br /> ❑ Back Flow Prevention <br /> Q/ 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 /> 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 /> (# Qt��4LITY,, <br /> ETI <br /> Chlorine <br /> pH _....._...--- - <br /> Cyanudc Acid <br /> Clarity <br /> ❑ Test Kits ... <br /> M. S us, <br /> El Supervision&Control - <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: ( 0 PCs( i/ <br /> i1 Time In: (� _' Rec ived B In ted by: <br /> Effluent: 0 P n ^II <br /> Time Out: 0 r04 4 Z�_ <br /> EHD 36-01 7-31-09 SWIMMING POOL OR f Page_of[� <br />