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Site address uipool(s) er// 7• V.; <br />City C 740 1--r <br /> <br />-...11111•••••••••••••• <br />Niiinber Nwinuning pools, spa pools. %vading pooh or special putpose pools at the site <br />verify that I arii the ownorrhome oweier association presidattllogally responsible petson for the <br />above named pool(s) end that I had the riooK&) inspected for tomplishee with Sectice 116049_1 <br />(a-f) of the Califoraig Health and Safety Code. <br />na / me /1/ Priru / <br />Signinuic <br />Addict:a /4'bPoP•f /7 5 1uy <br />City 1.5),,Dilii? St 77v, _zip 7524(0 <br />Telephone (.47 72. ) 70 2— 3 6, <br />0 There is no pool light in thirithese pool(s). Indicating there Is no pool light means that <br />is no light fixture. light- easing, or recesard light nicht, whether working or not <br />working. within the confinea of the goal shell. <br />Date <br />Paer-ir Far Note 7671 0 5 ifigal" I <br />1rQ _5 hco.t.ix-N p.„, <br />1 <br />.. C.r /Ng CC <br />r'lw.,01, <br />plAh Cat Serv;est <br />I '11, ligI I <br />CHEM SERV V] 002 10/06/99 WED 14:47 FAX 805 532 1288 <br />Sep-16-99 0322P <br />PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />Karcn Furs:, M.D.. M.P.H._ Health OFR= <br />504 Extz Weber Avenue, Marl Fltuor Stockton. CA 95n2 <br />209/468-3420 <br />VERIFICATION OF COWL IANC'E WITH CALIFORNIA HEALTH AND <br />SAFETY CODE, SECTION 116049.1 (E4) <br />Please attach a copy of the coropkted and signed itupeetion permit or report from the local <br />building department and send to: <br />Sea Joaquin County <br />Pohlle Hesith Services <br />Environmental Health Division <br />flEcrestional Health Program <br />StIt4 vast Weber Avenue, Third Floor <br />Stockton, CA 95202 <br />;00.- 44JS g3q, <br />4 <br />%oe/ /-14 <br />9)32Z. 2-- <br />tL 70/0