Test site Pool Inspection Report

Swimming Pool / Spa
Inspection Report

Linn County Public Health
1020 - 6th Street SE
Cedar Rapids, IA 52401
Phone: (319) 892-6000 Fax: (319) 892-6099
E-mail: health@linncountyiowa.gov

Facility Name: Test site

Address:	1020 6th St, SE
	Cedar Rapids, Iowa 52401

Person Contacted: Test Owner
Title: Owner
Registration No: 9999999
Type: Follow-up

Water Quality Information
Name:	SP999
Registration No:	9999999
Area (Sq. ft.):
Volume (Gallons):	9999
Filter Type:
Filter Rate:
Turnover Rate:
Chlorine (Free):
ORP:
Pool: 1-8ppm, ORP 700-880 mV If less than 0.6ppm or greater than 8.0ppm = closure Spa: 2-8 ppm ORP 700-880 mV If less than 1.0ppm or greater than 8.0ppm = closure
Chlorine (Total):
Chlorine (Combined):
Bromine:
Pool: 2-18ppm Spa: 4-18ppm

Water Quality Information (continued)
Cyanuric Acid:
Must be less than 80 ppm
pH:
Pool and Spa: 7.2ppm-7.8ppm If less than 6.8 or greater than 8.2 = closure
Total Alkalinity:
Calcium Hardness:
Temperature (F):
Spa must not exceed 104°
Type of Disinfectant:
Disinfection make and model:
Drain Cover make and model:
Drain Cover exp. date:
CPO:
CPO exp. date:

Smoke Free Air Act
1. Facility in compliance with smoking ban?
Yes	No
( If no, complete complaint form )

Notes: TEST ONLY, DO NOT BILL

	Name		Date
Inspector:		Inspection:

Report Received By:		Received:
Reviewed By:		Reviewed:

These items must be corrected as soon as possible in order to comply with the Iowa Department of Public Health Swimming Pool and Spa Rules. A letter regarding the actions which will be taken in order to correct all deficiencies must be submitted within 30 days to this office. If for any reason you take issue with any of the items cited regarding swimming pool rules, a variance can be requested by following the instructions in the Iowa Department of Public Health Swimming Pools manual, amended July 8th, 2009, page 57, section 641-15.7 (135I). Variance requests regarding spa rules must be made in compliance with the instructions in the Iowa Department of Public Health Spa manual, revised July 8th, 2009, page 32, section 641-15.7 (135I).