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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <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 I <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 />III Filters \ <br />• Pumps .. <br />, ' , _;.r • Chlorinator <br />• Flowmeter <br />• Gauges <br />• Skimmer & Gutters <br />• Back Flow Prevention <br />• Main Drain Cover <br />, <br />• Equalizer Line Cover <br />CONSTRUCTION <br />t • Pool Shell <br />s - • Fencing/Gates <br />• Decking & Coping <br />(7 \ f")' ,, • 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 />MI Toilet & Dressing <br />. Ventilation <br />WATER QUALITY <br />Chlorine <br />pH <br />Cyanuric Acid <br />Clarity I <br />Test Kits <br />MISCELLANEOUS l <br />Supervision & Control <br />General Sanitation <br />Algae <br />, <br />Influent: i <br />_ , . <br />Effluent: <br />Time In: Received By: III Inspected by: <br />Time Out: ) <br />EHD 36-01 5/26/05 Page of