Name of Designated Pool Operator * Date of Pool Opening * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Facility Information Facility Name * Address * City * Postal Code * Telephone Number at the Facility * Facility Hours of Operation * Pool Class * A B Wading Pool Splash Pad Is the facility * Indoor Outdoor If outdoor, dates facilities is open: Maximum Bather Load * Water Meter Available? * Yes No Is the Facility Supervised at Any Time? * Yes No Does the pool have multiple skimmers with equalizer fittings? * Yes No Have all of the equalizer valves (if applicable) been rendered inoperable? Yes No Do you require a Pool Operator’s Manual? * Yes No Owner/Operator Information Registered owner of the premises * Address: * City: * Postal Code * Name of designated facility operator * Operator’s phone number: * CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
