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�In... SAN JOAQUIN COUNTY <br />ENS ...ONMENTAL HEALTH DEPARTMI AT <br />600 East Main Street, Stockton, CA 95202-3029 <br />wFo N Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address:'*116 4 <br />City: Zip Code: 1151 <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Inspection Typq&vaR <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />Reinsp ction on or after: <br />Other: <br />RECIRCULATION EQUIPMENT <br />T e marked violations represent Health & Safety Code Violations and must be corrected as indicated: <br />❑ Filters <br />❑ Pumps <br />❑ Chlorinator <br />❑ Flowmeter— <br />Gauges�UL� <br />� <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />❑ Main Drain Cover <br />% det&r <br />❑ Equalizer Line Cover <br />__.. CONSTRUCTION - <br />i <br />❑ Pool Shellnet <br />❑ Fencing/Gates <br />f 4� t {t�a , {Lt�•tM/ <br />❑ Decking & Coping <br />❑ Wade Pool — 2 Main Drains <br />SAFETY EQUIPMENT <br />C <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 />Ej Emergency Shut-off Switch <br />❑ 6howers <br />❑ Toilet & Dressing <br />❑ Ventilation <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 />Effluent: <br />Time In: <br />Received <br />j By: <br />� I <br />Inspected by: <br />Time Out: <br />EHD 36-01 7-31-09 SWIMMING POOL OR Page —/ of 4— <br />