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p4�•!!y SAN JOAQUIN COUNTY <br /> g. VIRONMENTAL HEALTH DEPX /TENT <br /> ` 186b East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C4��FOR% Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: LA Date: Z <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: 04Inspection Type: <br /> Flow Rate pm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> r� Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health& Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters ^-4(,,, „ -M A <br /> [I Pumps __ -✓�w� (•� - <br /> ❑ Chlorinator <br /> ❑ Flowmeter <br /> El Gauges f L� <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover — <br /> ❑ Equalizer Line Cover A C <br /> CONSTRUCTION <br /> ❑ Pool Shell _... t4— ;int - <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping - <br /> ❑ 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 /> ❑ Emeraency Shut-off Switch <br /> RESTROOMS <br /> ❑ Showers <br /> ❑ Toilet&Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑ Chlorine <br /> ❑ PH - <br /> ❑ Cyanuric Acid <br /> ❑ Clarity - <br /> ❑ Test Kits <br /> MISCELLANEOUS <br /> ❑ Supervision & Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: Received By: In ected by: <br /> Effluent: , <br /> Time Out: ok k (/ �Z <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR % Page of <br />