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Pa..ln.. SAN JOAQUIN COUNTY <br />EN% )NMENTAL HEALTH DEPARTM r <br />e 1868 East Hazelton Avenue, Stockton, CA 9520.5-0232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sigov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: — Date: _ Z <br />Address: q City: Zip Code: 3 <br />Owner/Operator: ?2 }-O. l y V - _ Telephone: <br />Program Element: 3b rogram Record: Q Inspection Type: <br />Flow Rate (gpm): <br />pH: <br />Chlorine. (ppm): <br />C � 0-'2 <br />2 <br />Cyanuric Acid (ppm): <br />Temp: <br />Reinspection on or after: <br />Other: <br />_ <br />The marked violations represent Health & Safety Code Violations and must be corrected as indicated: <br />❑ Filters <br />❑ Pumps <br />1 <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />" C0NSTRI)'CT ON'... <br />❑ Pool Shell <br />Fencing/Gates <br />_❑ <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 />❑ Emergency Shut-off Switch <br />RESTROOMS.:: _. <br />❑ Showers <br />❑ Toilet & Dressing <br />❑ Ventilation <br />-- - <br />WATER QUALITY: <br />❑ Chlorine <br />❑ pH <br />❑ Cyanuric Acid <br />❑ Clarity <br />❑ Test Kits <br />❑ Supervision & Control <br />_ <br />❑ General Sanitation <br />❑ Algae <br />Influent: L <br />Effluent: 22 <br />Time In: 1. SS <br />Received By: <br />Inspected by: <br />K l� () "Mr C, <br />'Abe -03 <br />Time Out: (2'. r5 <br />EHD 36-01 5-8-12 SWIMMING POOL OIR Page — of <br />