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PUBLIC FitALTH SERVICES ,ck.!f,1 <br />.'Foc..,, <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION Firrfit;1,1 <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 COMPLIANCE WITH CALIFORNIA HEALTH AND <br />SAFETY CODE, SECTION 116049.1 (a-f) <br />Site address of pool(s) 355 Morri i LN 0. <br />City <br />Number of wi,mming pool, spa pools, wading pools or special purpose pools at the site <br />0 &I e <br />I verify that I am the owner/home owner association president/legally responsible person for the <br />above named pool( )And tillacqlati-6te pool(r) inspected for compliance with Section 116049.1 <br />(a-f) of the California Health and Safety Code. <br />Print name 6114-kr Ai NCFY Date -]-(//,_yt lq 19 <br />Signature ZelOice)(_ kce („zgati <br /> <br />Address <br />City St <br /> <br />Zip 953 <br /> <br />Telephone ( -3 - ,V 73 <br /> <br />E 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 cop of the completed and signed ins ection permit or report from the local <br />building department or the qualified contractor and send to: <br />San ..ro-i-citim County <br />Public Health Services <br />Environmental Health Division <br />Recreational Health Program <br />304 East Weber Avenue, Third Floor —o <br />Stockton, CA 95202 <br />cri <br />A Dr.•;,,ion San oaqum !-?ratth C.Ire ervIt:cs