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POOL OWNER and ADDRESS: <br />I. PHYSICAL PLANT <br />Age of Pool: <br />Type of Pool: <br />_1 < <br />PHONE NO. <br />,-- <br /> <br />years <br />Recirculating, Fill and draw, <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SWIMMING POOL SURVEY FORM <br />Date of Survey: <br />BUSINESS NAME and ADDRESS: 6 — <br />Combination Recirculating and Fill and Draw. <br />Size of Pool: <br />Depth, <br />Filtration: <br />6 0 Length, Width, 3 Shallow End <br />bo - Deep End Depth p,0-0-0 , Gallons Capacity. /tool) <br />or pi <br />Type of Filter: „.sS.(and, D atomaceous Earth, <br />Automatic slurry-fed, Diatomaceous Earth, <br /> Other. <br />No. of Filters: , Size 5(..)/1 Make and Model <br />Nos. . Capacity in gals/min/Sq.ft. of surface <br />area <br />Input pressure gauge reading: before backwash, <br /> after backwash. <br />Outlet pressure gauge reading: before backwash, <br /> after backwash. <br />Pump size: h.p., Pump capacity: G.P.M., <br />Turnover rate: hrs. <br />Skimming device: scum gutter, skimmers <br />CHLORINATOR: gas, liquid, hand, other <br />POOL APPROACH: concrete, lawn, sand, <br /> other (specify) <br />FENCE: height, self closing gate (yes or no) <br /> pool completely enclosed (yes or no) <br />EH Nv, 15 (a)