Laserfiche WebLink
PUBLIC FIEALTH SERVICES <br />oWN <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION \. <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 />Site address of pool(s) 0 0 IA-45 frtaw- 4er:)41.6 <br />City `'he--k•--('N <br />Number of swimming pools, spa pools, wading pools or special purpose pools at the site g. <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 1E, Date - <br />Signature <br />Address 3 t(c)0 Wet (3 h"e_ t <br />City St St Co... Zip <br />Telephone ( ) qa, --3400 <br />El 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 or the qualified contractor and send to: <br />San Joaquin County <br />Public Health Services <br />Environmental Health Division <br />Recreational Health Program <br />304 East Weber Avenue, Third Floor <br />Stockton, CA 95202 <br />A Don or .ian loakpin C.untv licalth Care Service's <br />IM76-956-602 <br /> RaII 013 P3 e6D:OI 66 SI InC