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Site address of pool(s) ,t3P10 <br />City Er-- <br />Number of swimming pools, spit pools, wading pools or special purpose pools at the site <br />DI) <br />1 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-t) of the California Health and Safety Code. <br />Print name Z7e-cf-C Date C <br />Signature <br />Address bi'Gc. ik) .1cc1 <br />City re-A.c.4 St Zip 91C-37-4 - <br />Telephone ( Zer", ) 8'34 <br />D 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 />JUL-01-1999 09:00 MOTEL 6 H0278 209 833 1949 P.02 <br />PUBLIC HI ALTH SERVIC <br />SAN JOAf,,UIN COUNTY <br />ENVIRONMENTAL HEALTH ENVISIONS <br />Karen Furst, M.D, fv.I.P.1-1., Health Officer <br />304 East Weber Avenue, Third Floor • Stockton, CA 95202 <br />20*468-3420 <br />VERIFICATION OF COMPLIANCE WITH CALIFORNIA HEALTH AND <br />SAFETY CODE, SECTION 116049.1 (a-0 <br />Please attach a copy of the coaXpleted 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 )1vIsiun tlf Joaquin Lottilly Hcalth CJIA: <br />