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SWIMMIN 13�POOL OFFICIAL INSPECTION R7TORT <br /> SAN JOA N COUNTY PUBLIC HEALTH : 7CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, TMRD FLOOR <br /> STOCKTON, CA 95202 <br /> (209)468-3420 <br /> TOA <br /> BUSINESS ADDRESS <br /> 24o r L4 1 NG e R TER NUMBER <br /> OWNERS NAME/DBA1 � IN <br /> MAILING ADDRESS <br /> PERMITIUCENSE PROGRAMIELEMENT aERVICE OUT <br /> IPC ' h h 1 I e <br /> RATE OF FLOW pH CL TEMP OTHER <br /> sTR OPER .The marked items represent Health Code violations and must be correctai as <br /> w Fillers 1 2 follows: <br /> a Pumps 3 4 _ <br /> D Chlorinator 5, 6 <br /> wFlowmeter 7- 8 <br /> 0 Gauges 9' 10 <br /> Skimmer a Gutters 11 12 / <br /> 7 <br /> Back Flow Prevention 13 14 L /t <br /> 2 Waste Water Prevention 15i 116 1r <br /> w Water Supply a Quality 17: 18; <br /> cc Pipe a Fittings 19; <br /> O Pool She" 20 <br /> Z 1- emtom a Sides 21; 22 <br /> U¢ Decking a Coping 23 24 Ct <br /> � Diving Boards 25 26� <br /> Revere Palo 27! 28; 6 Gaye/' <br /> i or <br /> Life Rings 29! 30. <br /> w Safely Signs 31; 32` <br /> a Lifeguard 33: Io <br /> e <br /> 0 Lighting Else. 34' 35 l.J <br /> w <br /> � <br /> Ladders 38' 37 <br /> LL Depth Markers 38 39' <br /> H First Aid Kits 40; 41' <br /> Gas Masks 42; 43. ' <br /> rn Snowara 4644 45 <br /> W O Toilet d greasing ' 47 P A 17 ir If <br /> ¢M ventilation 48; 49: <br /> Chlorine 50 <br /> pH 51 <br /> OOQ Cyanurates 52: <br /> a0 Clarity 531 <br /> Test Kits 54: a U <br /> o: SuDerYislon a control 55' <br /> w [. ,A <br /> S General Sanitation SG rep ijeAJ <br /> O Mlaceuanesua 57: <br /> POOL STATUS: (MARK ONE) <br /> E 5❑6 G 5❑9 F 6❑0 P 11 C 6F r u <br /> RECEIVED BY: <br /> ars RT <br /> PAGE <br /> _PMS EH.52"ll") � �_�`_ V 'ti <br />