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b <br /> r <br /> �nLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> z� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> 304 East Weber Avenue, Third Floor - Stockton, CA 95202 <br /> 209/468-3420 <br /> VERIFICATION OF COMPLIAINCE WITH CALIFORNIA HEALTH AND <br /> SAFETY CODE, SECTION 116049.1 (a-t) <br /> Site address of pool(s) 3 5 5 M 0 F F /4 1 5 LV O. <br /> city M A NL rE C . <br /> Number of .vi.*n.*ning pool , spa pools, wading pools or special purpose pools at the site <br /> cwe <br /> I verify that I am the owner/home owner association president/legally responsible person for the <br /> above named pool{-}A#d fiat J-jiadhe pool(!-)inspected for compliance with Section 116049.1 <br /> (a-t) of the California Health and Safety Code. <br /> Print name ° �� t" Date <br /> Signatur&� A&AnL <br /> I! l <br /> Address <br /> City /�;� '�/3'L-�C - St Zip <br /> Telephone W,)_ -3 ' q 73 <br /> I <br /> ❑ There is no pool light in this/these pool(s). Indicating there is no pool light means there <br /> is no light iixzure, 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 or the ua i led contractor and send to: <br /> San . oaquin oun <br /> Public Health Services <br /> Environmental Health Division 7. <br /> Recreational Health Program — <br /> 304 East Weber .avenue, Third Floor <br /> Stockton, CA 95202 <br /> A Dr.-;siun ,)r San `oayuin 1...mnty Health C-:re Servic,!s <br />