Full Text
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Community Environmental Health and Food Protection Report on Operation of Swimming Pool at (name of city, village or town in which pool is located) Name of Pool For Month of 20 County Date Filter Washed Check Pool Cleaned Check Total Number of Bathers Chlorine Used lbs/day gals/day - crock DOH-1323 (10/04) p 1 of 2 Alkalinity mg/l CaCO3 pH Pool Drain Visible Check Acid quarts pounds Soda Ash (pounds) Other Remarks Time Free Total Residual mg/l Chlorine Bromine Disinfection 1st Test 2nd Test 3rd Test GEN-148 Please see reverse side for important instructions At the end of each month, mail completed report to: Operator’s Signature Date Source of Water *Pints of % chlorine in gallons of water Time Free Total Time Free Total 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ---PAGE BREAK--- Swimming Pool Disinfection Instructions 1. The swimming pool disinfectant residual must be checked at least three times (3x) a day, especially before and after periods of heavy bathing. 2. The minimum disinfectant residuals to properly disinfect a pool are stated in Section 6-1.11(c) of Subpart 6-1 of the New York State Sanitary Code. Spa disinfectant residuals are stated in Section 6-1.25(c). A summary of the chlorine/bromine residuals are as follows: For a pH range of 7.2-7.8 minimum concentration of .6 mg/l free chlorine (ideal pH approximately 7.5): residuals (spas - 1.5 mg/l free chlorine residual); maximum concentration of 5 mg/l free chlorine residual . minimum concentration of 1.5 mg/l bromine residual (spas - 3.0 mg/l); maximum concentration of 6 mg/l bromine residual. For a pH range of 7.8 - 8.2: minimum concentration of 1.5 mg/l free chlorine residual. Use of chlorine compounds containing cyanuric acid is not acceptable. Chlorine and bromide levels must be measured by the DPD method. 3. The chlorine sample should be taken between the pool inlet and outlet, at approximately a 12" depth. 4. Note in the remarks column any unusual circumstances; i.e., pump failure, reason for pump and filter not operating, testing of ground fault interrupter, if applicable, and cloudiness of pool water, etc. 5. The county or district health department must be immediately notified of any change in equipment, interruption in treatment, loss of water clarity, or serious injury. DOH-1323 p 2 of 2 (10/04)