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Donna K. Heran, R.E.H.S. <br />Director <br />Laurie A. Cotulla, R.E.H.S. <br />Assistant Director <br />• ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />304 East Weber Avenue, Third Floor <br />Stockton, California 95202-2708 <br />Telephone: (209) 468-3420 <br />Fax: (209) 464-0138 <br />Website: WWW. Si go v.orglehd/ <br />Program Coordinators <br />Carl Borgman, <br />Mike I luggins, R.E.II.S., R.D.I. <br />Margaret Lagorio, R.E.H.S. <br />Robert McClellon, R.E.H.S. <br />Jeff Carruesco, R.E.H.S. <br />Kasey Foley, R.E.H.S. <br />Facility Name: (--ka f- <br />Facility Address: t-k'k l'AC" C-ArAL <br />Owner Name: GIO0c\kek.,.avl 5\--Ock.:k-z),-, <br />Authorized Representative: <br /> <br />L1--c, k\ ey-vta'vtat <br /> <br />EAccI 1 ertAck'v..ckz. am the owner or authorized <br />representative of the swimming pool and or spa at the above mentioned location. I <br />am providing the San Joaquin County Environmental Health Department (EHD) <br />with this notice of my intent to: <br />Provide a plug for the equalizer line(s) with a flush wall mount fitting. I <br />understand that by sealing the equalizer line, damage may occur to the pump <br />if the water level of the pool/spa falls below the skimmer level. At the time <br />of resurfacing, the plug will be removed and the approved suction <br />cover(s) will be installed over the equalizer line(s). Equalizer lines may <br />have to be separated by 3 feet, measured from center to center of pipe. <br />0 Close the pool until the approved suction cover is installed over the <br />equalizer line. I agree to call EHD for a clearance inspection prior to re- <br />opening the pool/spa. <br />Reason for not installing approved equalizer line covers: <br /> Date: IA'So(Ocr Signature: <br />Title: P?coverkx1 i'Vcanck?\er • C-0./-