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Site address of pool(s) c1ovi2 _C. 2)/2. <br />City S-7-0 C. to <br />Number of swimming pools, spa pools, wading pools or special purpose pools at the site / <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 <br /> <br />(jA/Gr- Date —98 <br /> <br />Signature <br />Address 6 9VVA-7,./ia4z.,eri,4.--jeid 7772_ <br />City St (IX zip 9, / 9 <br />Telephone ( c,7C) ) -V7 ef- .5/57 <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 />San Joaquin County <br />Public Health Services 691-40 ')Ja)((cA0b13 <br />Environmental Health Division <br />PULIC IlEALTH SERVICES <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />`7 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 />Please attach a copy of the completed and signed inspection permit or report from the local <br />building department and send to: <br />Recreational Health Program <br />304 East Weber Avenue, Third Floor <br />Stockton, CA 95202 <br />i\J CcrE : ..STO C. KT-0 A) 0/L. 2, /A14 Depr. 7ei-= Pa alb 7-6 --7--7J ?kg) L Tr c/2- AFRami rai2- 0). A Division of San Joaquin County Health Care Services