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P.�m. SAN JOAQUIN COUNTY <br />ENVIriONMENTAL HEALTH DEPARTN—AT <br />'• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Boa • Telephone: (209) 468-3420 Fax: (209) 468-3877 Web: www.sjgov.org/ehd <br />SWIMMING POOL OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />- /1 4 <br />Date: <br />Address: 5ek <br />Lkaa6. City: <br />Zip Code: <br />Q <br />Owner/Operator: <br />Telephone: <br />— Z <br />Program Element: Program ecord: <br />Inspection Type: <br />Flow Rate (gpm): <br />pH: <br />Chlorine (ppm): <br />Cyanuric Acid (ppm): <br />Temp: <br />R inspection on or after: <br />Other: <br />RECIRCULATION EQUIPMENT <br />The marked violations represent Health & Safety <br />Code Violations and must be corrected as indicated: <br />❑ Filters <br />Y N <br />❑ Pumps <br />t� <br />❑ Chlorinator <br />❑ Flowmeter <br />❑ Gauges <br />OK , <br />❑ Skimmer & Gutters <br />❑ Back Flow Prevention <br />�lh <br />�S <br />❑ Main Drain Cover <br />❑ Equalizer Line Cover <br />' CONSTRUCTIONS "' <br />❑ Pool Shell __ <br />❑ Fencing/Gates <br />❑ Decking & Cop ng <br />❑ Wade Pool - � Ma.n Drains <br />SAFETY EQUIPMENT <br />- <br />❑ Rescue Pole _ <br />❑ Life Ring <br />❑ Safety Signs <br />❑ Lifeguard <br />❑ PooUDeck ' <br />❑ Ladders/Hand Rails <br />❑ Depth Markem riles <br />❑ First Aid Kits <br />❑ Emergency shut-off Switch <br />RESTROOMS <br />❑ Showerslwt- <br />❑ Toilet & Dressing <br />❑ Ventilation <br />WATER QUALITY <br />❑ Chlorine^ <br />yt_ <br />r� <br />El pH <br />❑ Cyanuric Acid <br />a'ja <br />❑ Clarity <br />❑ Test Kits <br />MISCELLANEOUS <br />f 0 <br />❑ Supervision & Control <br />❑ General Sanitation <br />❑ Algae <br />Influent: <br />Effluent: <br />Time In; /D; 'T4 <br />c a i v a d By: <br />1 <br />s ec <br />L'� <br />by: <br />Time Out: �•, " <br />EH038-075-e42 SWIMMING POOL OIR Page of <br />