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Op...U NSAN JOAQUIN COUNTY <br /> ..... C <br /> 2" EN v iRONMENTAL HEALTH DEPARTMENT <br /> R. 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> • c .. -�' Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 4� FORS\ <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: 3 j. Date: - - <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: V%V - rl(� <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 /> ❑ Filters t Qt" j, owyrvAck r�-'v ( t►��5 C <br /> ❑ Pumps <br /> ❑ Chlorinator u,v V— PCMQ <br /> ❑ Flowmeter <br /> ❑ Gauges Y� tr►� . �l� <br /> ❑ Skimmer&Gutters 1 cq <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Coverr � <br /> CONSTRUCTION �f <br /> ❑ Pool Shell 2 <br /> ❑ Fencing/Gates *L64 o a0 <br /> ❑ Decking&Coping �r <br /> ❑ Wade Pool-2 Main Drains t:OV e.✓ S `l�� t� °L <br /> SAFETY EQUIPMENT N <br /> ❑ Rescue Pole <br /> ❑ Life Ring V'4-41-V' CI- V/&O I� c-� <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 /> ❑ Toilet&Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑ Chlorine J ,L+ <br /> ❑ pH — <br /> ❑ Cyanuric Acid Q, ��•�Cr <br /> ❑ Clarity I - - - - <br /> ❑ Test Kits <br /> MISCELLANEOUS V <br /> ❑ Supervision&Control - <br /> ❑ General Sanitation b y <br /> ❑ Algae <br /> Influent: <br /> Time In: Receive y: Ins ect by: <br /> Effluent: Time Out: <br /> l <br /> EHD 36-015/26/05 Page_of <br />