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ENIV AAONNIENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> BUSINESS ADORESS DATE 33 3 <br /> OWNER'S NAMEl OSA t- COMPUTER NUMBER <br /> MAILING ADDRESS V TIME IN <br /> U' <br /> PERMITILiCENSE PRGGRwMrELEMENi Rv,CE TIME OUT <br /> RATE OF FLOW?j/ NCK PH <br /> s of 7. 2 ca F . G EMP OTHER <br /> q r S U <br /> r t3 <br /> rvxL Gere y• G <br /> comb �. <br /> SIR OPER The marked items represent Health Code violations and must be correcte), as <br /> LUZ Filters 1 2 follows: - <br /> LU <br /> a Pumps <br /> 0 Chlodnator s, 6 % /�/t7� Y!/� s.Si/7 rC� �;i'C r✓� � rS�" <br /> Ow Flowmeter 7 8 J <br /> 9' To— <br /> Gauges /'tfgi,1/fi eL 44� <br /> Skimmer a Gallen 11 12 <br /> Back Flow Prevention T3--14 Yre c- <br /> O Waste Ware,Pre•anllon 155 16 - <br /> Wwater supply d Quality 17. 18, <br /> ¢ Pipe a Fillings 19; <br /> O Pool Shell <br /> ZU Bottom S Sides 21' 22 <br /> OU¢ Decking d Caping 23 24 i / t�'(�� G+�°'L.Ci1 .�' r�s^-Y`( �n� �'1YIL - <br /> t' Diving Boards 25 26: <br /> Assure Pole 27! 28; (j7�L U t^/r-Z- �y /(fW S <br /> z Lift Rings 29:. 30. <br /> 2 safety signs 317 32` <br /> 5 Lifeguard 33 <br /> LU O Lighting EleC. 341 35 <br /> iI- Ladders 36' 37 <br /> U Depth Markers 38 39- 61v— r-tt 7y� '-�/�C L 5 /ZV <br /> LL <br /> Q First Aid Kits 40[ Al. <br /> - <br /> w ^'^ <br /> Gas Masks 42, 43 b,,7 ' nm l� 'w•'V~ w �'�C'..'KY <br /> showers 44 45 <br /> ¢00 Toilet S Dressing 46! 47 0-ti� <br /> ¢ ventilation 48: 49. / . <br /> Chlorine 50 I //v'C.' - QS _ 1-4T P� <br /> PH <br /> 51 <br /> X02 Cyanurales 52- <br /> aO Ciarlty 53, �, <br /> Test Kits 54' CPR Sk/7 � i <br /> ¢ <br /> Sum"' <br /> &Control 55�: <br /> a' C7iZ S' !� a� I rJ-ee�L <br /> z Gonorel San)Mtbn 56 <br /> F iO miscellaneous $7, <br /> POOL STATUS: (MARK ONE) <br /> 58 59 60 61 E [] G [] F [] Pn Cn - <br /> I �/�Or Ltt,� Jg !jl✓a J� ECEIVE09Y_ <br /> yEA TrC <br /> oi•,S�l. n•:erjsl PAGE ' ..F � , <br />