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08/31/2009 13:18 2095453848 BURKETTS POOL PLAST PAGE 02/02 <br /> r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> gquip <br /> "a SAN JOAQUIN COUNTY< Donna K. Reran. R.F,.H.S. <br /> Program Can,R.E,KS. <br /> • n;.error 304 East Weber Avenue,Third Floor Curl Borgman,R.F,.,H.S. <br /> ,P Laurie A.Coro Oa,R.F,.H.S. Stockton,California 95202-2708 Mikc Huggins, R.E.H,S.,R.D.1. <br /> 4ciR6'dN� A.ssislonr Dircelor Telephone: Margarcl La orio, R.E.H,S, <br /> p one:(209)468 3420 Rolmn McC.Ilon, R.E.H.S. <br /> Fax: (209) 464-0138 leffCarracsco,R.E,H.S. <br /> Website:Www.sjgov.org/chd/ Kasey Foley, R.E.H.S. <br /> Facility Name: <br /> Facility Address: <br /> Owner Name: <br /> Authorized Representative: Q `` <br /> am the owner or authorized <br /> representative of the swimming pool and or spa at the above mentioned location. 7 <br /> am providing the San Joaquin County Environmental Health. Department (EHD) <br /> this notice of my intent to: <br /> Provide a plug for the equalizer line(s) with a flush wall mount fitting. I <br /> understand that by sealing the equalizer line, damage may occur to the pump <br /> if the water level of the pool/spa falls below the skimmer level. At the time <br /> of resurfacing, the plug will be removed and the approved suction cover(s) <br /> will be installed over the equalizer line, <br /> Cl Close the pool until the approved suction cover is installed over the <br /> equalizer line. I agree to call END for a clearance inspection prior to re- <br /> opening the pool/spa, <br /> Reason for not installing approved equalizer line covers: <br /> Signature; _P/ , �� Date: <br /> Title: <br /> D <br />