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1 <br /> SAN JOAQUIN COUNTY <br /> �O .caG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> V. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOtR CONTROL <br /> ONTR p p� <br /> VECTOR `/ INSPECTION FORM <br /> FDBA INSPE TIO DATE <br /> Structure Operation b1111512013 <br /> El 111. Well Construction PREMISE Aq44DDRESS R -I SPE ION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Management OWNE OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking 0\10"10-46C <br /> ❑ ❑ 1 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT ECO ID <br /> 1:1 E] 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> AKgRa-4e- <br /> ®- <br /> ❑ 117. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> d <br /> ❑ ❑ 9. Removal from Premises q11fA Q <br /> Structure Operation Vector control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation I Feeding/Water <br /> ❑ ❑ 18. Water Troughs t <br /> 1:1 1:119. Cups or Bowls <br /> El 1:1 20. Food Stora- e <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> �t <br /> Structure Operation Floors i <br /> 3. Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 171 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ I ❑ 1 16. Se tic System <br /> 1:1 El17. Sewer <br /> Structure Operation Rabies Vaccination RE EIVED BY INSPECT R <br /> 1:1 El18. Certificate on Premises 40 <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />