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P tL nee — <br />/ <br />Date: <br />opCity: <br />pH:Temp: <br />\oCF <br />VIOLATION MAJ <br />□ <br />□ <br />□ <br />□ <br />poC)\ <br />□ <br />Ceor^V^ <br />Received By <br />Page 1 of —EHD 36-01 Rev 08/08/16 <br />Time In <br />‘8'55^ <br />Time Out <br />ALL EHD STAFF TIME ASSOCIATED WITH BRINGING THIS FACILITY INTO COMPLIANCE, INCLUDING REINSPECTIONS, WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />Inspected By: <br />Pool Gates <br />Pool Enclosure <br />Safety Signs <br />Safety Equipment <br />Restrooms and Showers <br />Hose Bibb Anti Siphon Device <br />Pool Deck <br />Pool Deck and Lighting <br />Ladders and Handrails <br />Disinfectant Residual <br />Combined Chlorine Concentration <br />pH Level <br />Cyanuric Acid Concentration <br />Chemical Water Test Kit <br />Operation Records <br />Water Clarity <br />Cleanliness of Pool <br />Pool Shell and Tile <br />Depth Markers <br />Depth Marking Line <br />Water Level <br />Skimmer Assembly <br />Pool Inlets and Outlets <br />VGB Suction Covers <br />Spa Emergency Shut Off Switch <br />Spa Operating Temperature <br />Pool Equipment Room <br />Safety Vacuum Release System <br />Recirculation System Operation <br />Pool Equipment & Plumbing Maintained <br />Disinfectant Feeders <br />Chemical Control and Monitoring System <br />Minimum Turnover Time <br />Maximum Flow Rate <br />Program Record: <br />Chlorine (ppm): <br />□□ <br />□□□ <br />□□ <br />□□□□ <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br />Jo <br />21 <br />22 <br />23 <br />24 <br />25 <br />26 <br />27 <br />28 <br />H <br />30 <br />31 <br />32 <br />33 <br />34 <br />Q. <br />35 <br />36 <br />~37~ <br />~38~ <br />~39~ <br />40 <br />41 <br />42 <br />43 <br />44 <br />45 <br />999 <br />□□□□□□□□□ . <br />□□□□□□□□□□□□ <br />MAJ <br />□□ <br />Cyanuric Acid <br />(ppm): <br />^30 <br />OUT <br />□□□□□□□□□□ <br />COS <br />□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ <br />cos□□□□□□□□□□□□ <br />OUT <br />□□□□□□□□□□□ <br />MAJ = Major Violation OUT = Not in Compliance COS = Corrected on-site <br />See reverse side for code sections and general requirements that correspond to each violation listed below. Items listed on this report as violations do not <br />meet the requirements set forth in the California Health and Safety Code section(s) 116043, 116040, & 116050. All violations must be corrected within <br />specified timeframe. Violations that are classified as "MAJOR" pose an immediate threat to public health and must be corrected immediately or be subject to <br />closure pursuant to California Code of Regulations (Title 22) section 65545. <br />4-O-C \\ \ S p5 I* <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 frA v <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />Other: <br />I .H <br />________________________________________ <br />Name of Facility:Q. <br />Address: C <br />Owner/Operator: <br />Program Element: <br />Flow Rate (gpm): <br />rxoA- <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Zip Code: _________ <br />Telephone: 2^0^ < \ ' OOZ.^ <br />Inspection Type: <br />Reinspection on or after: <br />KSAvP <br />SWIMMING POOL OIR <br />V~\\cx \<\-Q <br />. 4 ppm. <br />prop___ <br />Ao oof (ecA~ ^c\S\ Vt . <br />\eoe\ oA AA-x? \ s <br />y c'-xV-V <br />GOcoWwA-ed -Ao <br />OAApp-o or , CgyA- <br />\p^ <r>ee A s • <br />r vJQy <br />____________VIOLATION________ <br />Flow Meters <br />Pressure and Vacuum Gauges <br />Electrical Hazards <br />Filter Cleaning and Maintenance <br />Wastewater Disposal <br />Spray Ground UV Disinfection <br />Spray Ground Pumps Interconnected <br />Spray Ground Recirculation System <br />EHD Approval Required <br />Lifeguard Certification <br />Lifeguard First Aid Equipment <br />Other