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op4�lk• SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMr-NT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �qc oRa�" Telephone:(209) 468-3420 Fax: (209)468-3877 Web:www.sigov.org/ehd (� <br /> SWIMMING POOL OFFICIAL INSPECTION REPOP,T p� <br /> Name of Facility: Z n Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: -3 — <br /> Program Element: Program Record: Inspection Type: <br /> Flow Rate(gpm): pH: Chlorine(ppm): Cyanuric Acid(ppm): Temp: e F Reinspection on or after: <br /> bo . r VV !_/ Other: <br /> RECIRCULATION EQUIPMENT The marked violations represent Health&Safety Code Violations and must be corrected as indicated: <br /> ❑ Filters 6 "t'L -C -6i 0 <br /> ❑ Pumps a <br /> El Chlorinator r o n- v !� 2� �0 <br /> ❑ GaugesFlowme <br /> QAC C � C <br /> ElGauges <br /> El Skimmer&Gutters Z �d�L �Gb / �"d- 1h , A4_0 <br /> ❑ Back Flow Prevention <br /> ❑ Main Drain Cover 1 4 <br /> ❑ Equalizer Line Cover 3 PA10 44Ahen4W4ba Id <br /> CONSTRUCTION n ! <br /> ❑ Pool Shell <br /> ❑ Fencing/Gates <br /> ❑ Decking&Coping r S. <br /> El (Wade Pool—2 Main Drains � H^ <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 /> M* <br /> ❑ Chlorine <br /> ❑ pH <br /> ❑ Cyanuric Acid <br /> ❑ Clarity <br /> ❑ Test Kits <br /> MISCELLANEOUS <br /> ❑ Supervision&Control <br /> ❑ General Sanitation <br /> ❑ Algae <br /> Influent: <br /> Time In: Ls Received By: Insp cttedd by: <br /> Effluent: Time Out: <br /> EHD 36-01 5-8-12 SWIMMING POOL OR Page of <br />