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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM,T <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address: City: Zip Code: <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 />• Flowmeter <br />• Gauges <br />• Skimmer & Gutters _ <br />III Back Flow Prevention <br />• Main Drain Cover <br />• Equalizer Line Cover <br />CONSTRUCTION <br />• Pool Shell o 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 />n Ventilation <br />WATER QUALITY <br />• Chlorine <br />• pH <br />• Cyanuric Acid <br />• Clarity <br />II Test Kits <br />MISCELLANEOUS <br />• Supervision & Control <br />• General Sanitation <br />• Algae <br />Influent: t <br />Effluent: <br />/- <br />Time In: ce Re ed By: Inspected by: <br />Time Out: • <br />EHD 36-01 5/26/05 <br /> Page / of