Laserfiche WebLink
PUBLIC HEALTH SERVICES <br />SAN JUAQUIN CO LINTY <br />A ENVIRONMENTAL HEALTH DIVISION lit A ; <br />r.7.• .\ 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 />e:7 F NED <br />MAY Z8 1999 <br />City .S+0 C k-c-OV1 jNiv ENAL HEALTH <br />Number of swimming pools, spa pools, wading. pools or special purpose pools at the site <br />SER /ICES <br />I verify that I am the owner/home owner association president/legally responsible person for the <br />above named pool(s) and that I had the pool(s) inspected for compliance with Section 116049.1 <br />(a-f) of the California Health and Safety Code. <br />Print name -P161 T -1- S C4 K Date ,06/ <br />signature <br />Address nO7S- 1/1/10A-R,u-us 09,1 <br />Zip 9 6 ,2 9 City Q0c-k&/\ St Cat <br />Telephone (O j J S r.? -) ( 0 <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 copy of the completed and signed inspection permit or report from the local <br />building department and send to: <br />San Joaquin County <br />Dr er4-, Public Health Services <br />or ace z Environmental Health Division <br />Recreational Health Program <br />304 East Weber Avenue, Third Floor <br />Stockton, CA 95202 <br />Site address of pool(s) 30357- Y v a Ar2As Dc <br />A Division or San Joaquin County Ha2lch Care Services