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SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SWIMMING POOL SURVEY FORM <br />Date of Survey: <br />BUSINESS NAME and ADDRESS: cHD,7 c j sa0;,( <br />/117 <br />POOL OWNER and ADDRESS: <br />I. PHYSICAL PLANT PHONE NO. <br /> <br />Age of Pool: r")- years <br />Type of Pool: Recirculating, Fill and draw, <br />Combination Recirculating and Fill and Draw. <br />Size of Pool: 5---0 Length, Width, Shallow End <br />Depth, <br />)( <br />Deep End Depth, Pk qc., Gallons Capacity. <br />Filtration: <br />Type of Filter: Sand, Diatomaceous Earth, 5 <br /> Automatic slurry-fed, Diatomaceous Earth, <br /> Other. <br />No. of Filters:, Size Make and Model <br />Nos. . Capacity in gals/min/sq.ft. of surface <br />area <br />Input pressure gauge reading: before backwash, <br /> after backwash. <br />Outlet pressure gauge reading: before backwash, <br /> after backwash. <br />Pump size: h.p., Pump capacity: G.P.M., <br />Turnover rate: hrs. <br />Skimming device: scum gutter, skimmers <br />CHLORINATOR: gas, liquid, hand, other <br />POOL APPROACH: concrete, lawn, sand, <br /> other (specify) <br />FENCE: height, self closing gate (yes or no) <br /> pool completely enclosed (yes or no) <br />EH Ny. 15 (a)