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Qat. ,ASI JUAUUIN 6UUM Y <br /> Zi E,, 'IRONMENTAL HEALTH DEPART --NT � o <br /> 186L est Hazelton Avenue, Stockton, CA 9b--S-6232 �0 pu <br /> k Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: C 5 n Date: g-- -) <br /> Address: 5 ( �-- City: Zip Code: <br /> Owner/Operator: Telephone: 9 <br /> Program Element:2,k,( l 1,2,lo 2- Program Record: S&Z-0- Inspection Type: _ <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspe tion on or after: <br /> Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health& Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters <br /> ❑ Pumps <br /> ❑ Chlorinator t . t <br /> ❑ Flowmeter n_ J �( 4?P <br /> ❑ Gauges tc� <br /> ❑ Skimmer&Gutters , <br /> ❑ Back Flow Prevention 5 � L n <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover d - <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping (� n <br /> ❑ Wade Pool-2 Main Drains C 1— P 1` &nocm C -3220 <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 /> ❑ Emergency Shut-off Switch <br /> RESTROOMS <br /> ❑ Showers <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation 3 110 C <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: R ceivetl Inspected by: <br /> (` Ur� <br /> y-- �ares <br /> Effluent: Time Out:"2' y _ 3 <br /> EHD 36-015-8-12 SWIMMING POOL OR LAyV1-V/v ky\kf`SO✓1 Page hof <br />