POOL NAME: _______________________________________________________ FOR WEEK BEGINNING ___________________________________ 20_________
(MUST BE KEPT FOR ONE YEAR)
DAILY – Must be taken within one-half hour of opening and at intervals not exceeding four hours until pool closing time.
CLARITY-IS THE MAIN DRAIN CLEARLY VISIBLE? CIRCLE [Y]ES OR [N]O FOR EACH TIME FRAME. *BOTH THE MANUAL TEST RESULTS AND AUTOMATED READINGS SHOULD BE RECORDED FOR EACH REQUIRED TME FRAME. *DISINFECTANT
pH
CLARITY
*DISINFECTANT
pH
SUN
- - -
- - -
Y / N
- - -
- - -
MON
- - -
- - -
Y / N
- - -
TUES
- - -
- - -
Y / N
WED
- - -
- - -
THURS
- - -
FRI
SAT
DAY
TIME
INITIALS
TIME
CLARITY
INITIALS
*DISINFECTANT
pH
*DISINFECTANT
pH
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
- - -
- - -
Y / N
WEEKLY
TIME
DATE TAKEN
INITIALS
TIME
CLARITY
INITIALS
TESTING LEVELS AND RECORDING INSTRUCTIONS DISINFECTANT RESIDUAL
TEST COMBINED CHLORINE CYANURIC ACID
CLARITY
RESULT
INITIALS
MINIMUM
CALCIUM HARDNESS
MAXIMUM
CHLORINE
0.6 ppm
1.0 – 8.0
ppm
8.0 ppm
BROMINE
1.0 ppm
2.0 – 18.0 ppm
18.0 ppm
pH
ALKALINTY
PREFERRED
6.8
7.2 – 7.8
8.2
ORP READING
650 mV
700 – 800 mV
880 mV
CYANURIC ACID
10 ppm
20-30 ppm
80 ppm
THE POOL SHALL BE CLOSED IF BELOW THE MIN LEVELS OR IF MAX LEVELS ARE EXCEEDED OR AT ANY TIME THAT THE MAIN DRAIN IS NOT VISIBLE.
RECORD ALL MAINTENANCE ACTIVITIES: MONTHLY (IF THERE IS A POSITIVE COLIFORM BACTERIA TEST, PLEASE CONTACT XXXXX COUNTY ENVIRONMENTAL HEALTH AT 515-XXX-XXXX) TEST COLIFORM BACTERIA FUNCTIONING GFCI OUTLETS FUNCTIONING SVRS
DATE TAKEN
RESULT POS / NEG
INITIALS
SUN
MON
TUE
WED
THU
FRI
SAT
BACKWASHED CHEMICALS ADDED VACUUMED
YES / NO YES / NO/ NA
POOL CLOSED
I certify that under penalty of perjury and pursuant to the laws of the state of Iowa that the preceding is true and accurate. Certified Pool Operator:_____________________________________________________ Date:____________________________
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