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Swimming Pool Incident Report Compliance Assurance Division Please Type or Print Clearly Section 1. Facility Information Name Permit Address County City State Zip Pool Type circle one A B C Phone Section 2. Owner Information Phone Number Section 3. Incident Information Type of Incident circle one a Drowning Date of Incident b Immersion c Cut/Abrasion Time Was 911 Ambulence or Emergency Room Visit Required circle one Name of Victim YES Age Witnes...
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Pool Incident Report
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