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ENV .AONIVIENTAL HEALTH DIVISION
<br />304 EAST WEBER AVENUE, THIRD FLOOR
<br />STOCKTON, CA 95202
<br />(209) 468-3420
<br />BUSINESS ADDRESS
<br />.2'gCC ) ' r‘1%,(‘
<br />!'
<br />\ J 6..
<br />DATE ,
<br />OWNER'S NAMEID A
<br />-.)
<br />1 A-0-r -1--'. i-- ris (\A :)(.,"1::-f -01 -e--7-14---
<br />COMPUTER NUMBER
<br />NO -5 690 I , 2-- )12. t._-_;•L n 9 •-1,--f
<br />umuNG AconEss
<br />X1A us d
<br />TIME IN
<br />PERMIT (LiGENSE. PROGRAM/ELEMENT
<br />I 1
<br />SERVICE TIME OUT
<br />RATE RATE OF FLOW pc..--t4 Zoc...044,
<br />,e
<br />PH pai "i."-1
<br />'2 .°, r-
<br />CL- pk &us& J. 2._
<br />(1.-orvi-b 4•-• 61pc.. , -°•1=
<br />TEMP
<br />'3-f 1
<br />OTHER fie,-24 C, tf-e-t; I C‘...'
<br />y.SW I Cr tope 0.1.
<br />CaT1-10 RECIRCULATION EQUIPMENT 1 SIR OPER
<br />Filters
<br />Pumps
<br />Chlorinator
<br />Flowmeter
<br />Gauges
<br />Skimmer & Gutters
<br />Back Flow Prevention
<br />Waste Water Prevention
<br />Water Supply & Quality
<br />Pipe & Fittings
<br />1 2
<br />3 4
<br />5 6
<br />7 6
<br />9• 10
<br />11 12
<br />13 14
<br />15: 16
<br />17, 18.
<br />191.
<br />Of 20
<br />p
<br />Z o
<br />ii-
<br />oo (..) cc
<br />vi
<br />Pool Shell
<br />Bottom & Sides
<br />Decking & Coping
<br />Diving Boards
<br />21- . 22
<br />23 24
<br />25, 26: SAFETY EQUIPMENT ROMP'S Pole
<br />Life Flings
<br />Safety Signs
<br />Lifeguard
<br />Lighting Elec,
<br />Ladders
<br />Depth Markers
<br />First Aid Kits
<br />Gas Masks
<br />271 28 ,
<br />291 30,
<br />31 32'
<br />34, 35
<br />36' 37
<br />38 39
<br />40. 41' ,
<br />42, 43
<br />cil i-2 to u10
<br />ccO CC
<br />Showers
<br />Toilet & Dressing
<br />Ventilation
<br />44, 45
<br />46 47
<br />48, 49. POOL QUALITY Chlorine
<br />pH
<br />Cyanurates
<br />Clarity
<br />Test Kits
<br />50
<br />,51•
<br />52
<br />53.
<br />54'
<br />cc
<br />lii
<br />I
<br />C5
<br />Supervision & Control
<br />General Sanitation
<br />Miscellaneous
<br />55 '
<br />56
<br />57:
<br />E
<br />POOL
<br />58
<br />—
<br />STATUS:
<br />G
<br />59
<br />r
<br />(MARK
<br />F
<br />60
<br />ONE)
<br />P
<br />61
<br />C
<br />62
<br />.c)6 4 L4-0:- 61
<br />
<br />, ...(-- 0
<br />S • ..)en cn P-4
<br />0,...s.,:,.., • ., • o
<br />The marked items represent Health Code violations and must be correctei as
<br />follows:
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<br />BY:
<br />e,"-N.--A.---- ..,
<br />CLAHST
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