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ENVIRONMENTAL HEALTH DEPARTMENT <br />Donna K. Heran, R.E.H.S. <br />Director <br />Laurie A. Cotulla, R.E.H.S. <br />.q Ci FSO R�` /iSSIS(ali(Director <br />Facility Name: <br />SAN JOAQUIN COUNTY <br />304 East Weber Avenue, Third Floor <br />Stockton, California 95202-2708 <br />Telephone: (209) 468-3420 <br />Fax: (209) 464-0138 <br />Website: vrww.sjgov.org/ehd/ <br />Facility Address: �SS3 �{ J`�o�. 19 U <br />Owner Name: W14 (4 V) e, T?g G6G <br />Authorized Representative:.�q�o <br />Program Coordinators <br />Carl Borgman, R.E.H.S. <br />Mike Huggins, R.E.H.S., R.D.I. <br />Margaret Lagorio, R.E.H.S. <br />Robert McClellan, R.E.H.S. <br />Jeff Carruesco, R.E.H.S. <br />Kasey Foley, R.E.H.S. <br />I L%Wp s' O f. Lo c. K 1 > v1 am the owner or authorized <br />representative of the swimming pool and or spa at the above mentioned location. I <br />am providing the San Joaquin County Environmental Health Department (EHD) <br />with 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 veQ.) the time <br />of resurfacing, the plug will be removed and t4t%pproKed suction <br />cover(s) will be installed over the equalizer line(s)''Tgnalizer lines may <br />have to be separated by 3 feet, measured from center to center of pipe. <br />❑ Close the pool until the approved sucrion Epver is installed over the <br />equalizer line. I agree to call EHD for a cle6e inspection prior to re- <br />opening the pool/spa. <br />Reason for not installing approved equalizer line covers: H <br />Signature: Z'�� Z;�a <br />Title: , <br />Date: <br />�r pe T� <br />