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SWIM' a POOL OFFICIAL INSPECTIU-FORT <br />SAN J�.. jUIN COUNTY PUBLIC HEALTF _RVICE <br />ENVIRONMENTAL HEALTH DIVISION <br />P n Rnx gnn9_ STOCKTON. CA 95201 <br />(Y j I <br />— — <br />OPER <br />DATE <br />Bl/SINESS ADDRESS <br />&' <br />Eirar <br />IZ <br />Z <br />1 � 9 <br />COMPUTER N NU BER <br />OWNER'S NAMEIDBA <br />(aQ <br />i <br />_t_,♦1 r1 <br />Yy <br />Lx rens <br />Pumps <br />TIME IN <br />MAILING ADDRESS <br />Chlorinator <br />5 <br />6 <br />PERMITILICENSE <br />Flowmeter <br />7' <br />8 <br />PROGRAMIELEMENT <br />SERrVICE <br />TIME OUT <br />10 <br />it <br />12 <br />1= <br />Skimmer' Gutters <br />T-Ivlpi <br />Back Flow Prevention <br />RATE OF FLOW <br />14 <br />PH <br />CL <br />TEMP <br />OTHER <br />17 <br />18- <br />w <br />Water Supply & Ouality <br />¢ <br />Pipe 8 Fittings <br />(Y j I <br />The marked items represent Health Code violations and must be corrected as <br />STR <br />OPER <br />r <br />Z <br />Filters <br />1 <br />2 <br />U.1 <br />a <br />Pumps <br />3 <br />4 <br />Chlorinator <br />5 <br />6 <br />Gw <br />Flowmeter <br />7' <br />8 <br />Gauges <br />9' <br />10 <br />it <br />12 <br />1= <br />Skimmer' Gutters <br />J <br />� <br />Back Flow Prevention <br />13 <br />14 <br />15 <br />16 <br />Waste Water Prevention <br />17 <br />18- <br />w <br />Water Supply & Ouality <br />¢ <br />Pipe 8 Fittings <br />19. <br />O <br />Pool Shell <br />0111A <br />20- <br />211 <br />22 <br />iU <br />Bottom & Sides <br />00¢ <br />Decking & COP Ing <br />23 <br />24 <br />Diving Boards <br />25 <br />26. <br />l <br />C r, a ✓' RC <br />Resurs Pole <br />27i <br />28— <br />F97 <br />o <br />Z <br />Life Rings <br />31 <br />32' <br />Safety Signs <br />lonk— i = 2 <br />33 <br />a <br />Lifeguard <br />O <br />Lighting Eac. <br />34' <br />35. <br />Ladders <br />36 <br />37. <br />38 <br />39 <br />LL <br />Depth Markers <br />W <br />First Aid Kits <br />4O <br />41 i <br />142, <br />43. <br />Gas Masks <br />�0 <br />Showerst48 <br />yy--�.z- / <br />SpTtmp- IV 0 0r -y N( a IKI0 <br />45 <br />47 <br />w0 <br />Toilet & Dressing <br />¢¢ <br />Ventilation <br />49 <br />Chlorine <br />50 <br />yy <br />�F <br />PH <br />51, <br />00< <br />Cyanurates <br />521 <br />Q. Z)0 <br />Clarity <br />53i <br />Test Kits <br />541 rr <br />¢ <br />Supervision & Control <br />55' <br />w <br />S <br />General Sanitation <br />56' <br />0 <br />Miscelleneoue <br />57; <br />POOL STATUS: (MARK ONE) <br />58 59 60 <br />61 <br />62 <br />E❑ G[] F[] P❑ <br />C❑ <br />The marked items represent Health Code violations and must be corrected as <br />uroam <br />Fs rucl re <br />tL-ldi <br />T— <br />kryun E ce, r res ; <br />, r a , <br />c, <br />l r v` v - AL<. <br />I v { I <br />ee L <br />on � I,ce. 0 c, LKt <br />c r. . <br />OV'Cr rIUOr r- `✓V Zli <br />r . CC r <br />r <br />� lT I s22c <br />i �I <br />l <br />C r, a ✓' RC <br />J <br />o <br />lonk— i = 2 <br />nreup, <br />y � <br />t <br />9 <br />(a 1vt I <br />D r10i 40 <br />O L ru, c <br />S �r <br />Poj <br />^ SIM —ca — z— <br />, <br />yy--�.z- / <br />SpTtmp- IV 0 0r -y N( a IKI0 <br />RECEIV 08Y; <br />1 r OFFICE ADDRESS - b'( �Q%� <br />445 N. SAN JOAQUIN ST., STOCKTON, CA <br />(NO MAIL IS RECEIVED AT THIS ADDRESS) <br />SANITARIAN'. <br />PHONE (209) 468-3420 <br />PAGE OF <br />