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BUSINESS NAME and ADDRESS: <br />POOL OWNER and ADDRESS: <br />0 C , <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SWIMMING POOL SURVEY FORM <br />Date of Survey: .$ <br />N. <br />I. PHYSICAL PLANT <br />Age of Pool: A, years <br />Type of Pool: Recirculating, <br />PHONE NO. <br />Fill and draw, <br />Combination Recirculating and Fill and Draw. <br />Size of Pool: <br /> <br />-y <br />C Length, ?c) Width, Shallow End <br /> <br />Depth, <br /> <br />Deep End Depth, <br />41-c.6L a7" <br />Gallons Capacity. <br /> <br />Filtration: <br /> <br />Type of Filter: Sand Diatomaceous Earth, <br /> Automatic slurry-fed, Diatomaceous Earth, <br />Other. <br />, <br />No. of Filters: , Size 5 (-) !,/'4 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, V 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 />51-1 1\1, 15 (a)