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N in charge of facility 5. Telephone No. 6. Copy checklist furnished to 7. Mailing address 8. Purpose of inspection Regular Courtesy (Check appropriate box.) Satisfactory Pre-opening Other (specify): SECTION I - WATER Unsatisfactory a. Free available chlorine residual (mg/L): shallow end deep end b. Combined chlorine (mg/L) (if measured): shallow end deep end shallow end deep end c. pH: d. Temperature: e. Visual clarity. f. Water sample collected for bacteriological analysis at s.

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