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a pP.4�IN. SAN JOAQUIN COUNTY , <br /> 2r Eft�MENTAL HEALTH DEPARTN,E <br /> 1868 past azelton Avenue, Stockton, CA 95205 0232 <br /> Telephone:(209) 468-3420 Fax:(209) 468-3877 Web:www.sjgov.org/ehd <br /> �P <br /> 9�FOPN <br /> SWIMMING POOL OFFICIAL INSPECTION REPORT <br /> Name of Facility: y Date: <br /> Address: Lt1 City: �(b z Zip Code: — 3 <br /> Owner/Operator: QA Z ` (�� �� �,� Telephone: <br /> Program Element: , Program Record: -� SV Inspection Type: . t <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: Reinspection on or after: <br /> cr C JVI� } Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters - -\\ _ <br /> ❑ Pumps - 1 1-C \z Y �`i"�✓ �- <br /> ❑ Chlorinator <br /> ❑ Flowmeter <br /> ❑ Gauges <br /> ❑ Skimmer&Gutters <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover <br /> ❑ Equalizer Line Cover 4ti 2 <br /> CONSTRUCTION <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping <br /> ❑ Wade Pool-2 Main Drains <br /> SAFETY EQUIPMENT <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 /> ❑ Emergency Shut-off Switch <br /> RESTROOMS - <br /> ❑ Showers <br /> ❑ Toilet& Dressing <br /> ❑ Ventilation <br /> WATER QUALITY <br /> ❑ Chlorine <br /> El pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits ----- -- <br /> MISCELLANEOUS <br /> ❑ Supervision&Control - <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Timeln: �` .�� Received By: Inspected by: <br /> Lin Ino��p2 <br /> Effluent: <br /> Time Out: �{1pg- O3 <br /> EHD 36-01 5-8-12 SWIMMING POOL OIR Page-A—of <br />