Laserfiche WebLink
.416 <br />PUBLIC FitALTH SERVILLS <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 <br />209/468-3420 <br />VERIFICATION OF COMPLIANCE WITH CALIFORNIA HEALTH AND <br />SAFETY CODE, SECTION 116049.1 (a-f) <br />Q U I ty <br />fur r• <br />/ <br />Site address of pool( 3 8 5- A El-flA CO" pueNve <br />s+crc47(0_1.) <br />NumberNumber of swimming pools, spa pools, wading pools or special purpose pools at the site 0,ve <br />I verify that I am the owner/home owner association presiden i egally responsible erso 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 it) &QRS Date 7- I <br />Signature <br />Addres e m u)00 s-51 S44) <br />fr &. I( (/ „044c,b2/4 ,frie 79la cd <br />City ,9i /eiMoSt ifozg5z-zip ?5-(r77 <br />Telephone ( D.0c f ) 4‘c-tz -s ‘? <br />El 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 />City <br />• <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 or San'io.iouin Count.: Health Care 6er.-i