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PUBLIC HEALTH SERVICi�S <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION - `) <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> 304 East Weber Avenue, Third Floor • Stockton, CA 95202 4�iFOR� <br /> 209/468-3420 <br /> VERIFICATION OF COMPLIANCE WITH CALIFORNIA HEALTH AND <br /> SAFETY CODE, SECTION 116049.1 (a-f) <br /> Site address of pool(s) Zj15--3L, &-b-Q �� <br /> City �cA-e � <br /> Number of swimming pools, spa pools, wading pools or special purpose pools at the site 2— <br /> I verify that I am the owner/home owner association president/legally responsible person for the <br /> above named pool(s) and that I had the pool(s) inspected for compliance with Section 116049.1 <br /> (a-f) of the California Health and Safety Code. <br /> Print name Lakeland Management Company Date n6-29-99 <br /> r,�a�Ajge dvisor for Brookside Master Association <br /> Signature <br /> Address p o R,,, <br /> City Stockton St CA Zip 95204 <br /> Telephone ( 209 473-6060 <br /> There is no pool light in this/these pool(s). Indicating there is no pool light means there <br /> is no light fixture, light casing, or recessed light niche, whether working or not <br /> working,within the confines of the pool shell. <br /> Please attach a copy of the completed and signed inspection permit or report from the local <br /> building department or the qualified contractor and send to: <br /> San Joaquin County <br /> Public Health Services <br /> Environmental Health Division <br /> Recreational Health Program <br /> 304 East Weber Avenue, Third Floor <br /> Stockton, CA 95202 <br /> A Division of San Joaquin County Health Care Services <br />