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SWIMMP`)OOL OFFICIAL INSPECTION RI RT <br />SAN JOAQuiN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON, CA 95202 <br />(209) 468-3420 <br />BUSINESS ADDRESS DATE <br />OWNER'S NAME/DBA COMPUTER NUMBER <br />MAILING ADDRESS <br />TIME IN <br />PERMIT/LICENSE PROGRAM/ELEMENT SERVICE TIME OUT <br />RATE OF FLOW pH CL TEMP OTHER RECIRCULATION EQUIPMENT SIR OPER <br />Fillers 1 2 <br />Pumps 3 4 <br />Chlorinator 5 6 <br />Flowmeter 7 8 <br />Gauges 9' 10 <br />Skimmer & Gutters 11 12 <br />Back Flow Prevention 13 14 <br />Waste Water Prevention 15: 16 <br />Water Supply & Quality 17 . 18. <br />Pipe & Fittings 19. i p CON- STRUCTION Pool Shell W 20 <br />Bottom & Sides 21' . 22 <br />Decking & Coping 23 24 <br />Diving Boards 25 26 , SAFETY EQUIPMENT Reeure Pole 271 28' <br />Life Rings 29'T 30, <br />Safety Signs 31 32' <br />Lifeguard <br />Lighting Elec. 34 35 <br />Ladders 36' 37 <br />Depth Markers 38 39 <br />First Aid Kits 40: 41 <br />Gas Masks 42, 43 <br />(J) <br />w 0 cc0 <br />li <br />Showers <br />Toilet & Dressing <br />Venlilatlon <br />44, 45 <br />46' 47 <br />48, 49. pobi 1 QUALITY Chlorine 50 <br />pH 51' <br />Cyanuraies 52. <br />Clarity 53 , <br />Test Kits 54' <br />Cr Supervision & Control 55 <br />111 <br />2 Genoral Sanitation 56 <br />0 Miscellaneous 57. <br />POOL STATUS: (MARK ONE) <br />58 _59 60 — 61 62 <br />E G F P C <br />// <br />PHS-EH 1,42 (A/W <br />The marked items represent Health Code violations and must be correctel as <br />(allows: <br />RECEIVED BY: <br />ENVIRONMENTAL /MALIN SPECIALIST <br />PAGE OF