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SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SWIMMING POOL SURVEY FORM <br />Date of Survey: 2-57-- 6 <br />BUSINESS NAME and ADDRESS:/6kkyv/iqk rte , <br />POOL OWNER and ADDRESS:/*Sei. Tq.77,pv-2 M-7—,p- <br />I, PHYSICAL PLANT PHONE NO. <br />Age of Pool: iZ years <br />Type of Pool: Recirculating, Fill and draw, <br /> Combination Recirculating and Fill and Draw. <br />Size of Pool: .k0 Length, ),-0 Width, :7 Shallow End <br />Depth, 64=— Deep End Depth)] Gallons Capacity. <br />Filtration: <br />Type of Filter: Sand, Diatomaceous Earth, <br /> Automatic slurry-fed, Diatomaceous Earth, <br /> Other. <br />No. of Filters: 5 Size 0 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, :7 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 />c_,c) <br />Pc° <br />••••••••••IIIT• <br />EH No. 15 (a)