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Qu�N SAN JOAQUIN COUNTY <br />i <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 />��FORa <br />VECTOR <br />CONTROL <br />NTR L ® C IN FORM <br />DBA INsPET `SDA ®� <br />Structure Operation Waler Well <br />❑ ❑ 1. Well Construction PREMISE ADDRESS RE -INSPECTION DATE <br />❑ ❑ 2. Cross -Connection__/_ -•30,003 `tea <br />Structure Operation Manure Mana erne Ow OPERATOR V ,PHONE <br />❑ E]3. Spreading and Di ing [ �), 2 -7r— fid. <br />❑ ❑ 4. Concrete Tanks INSP TION TYPE PROGRAM ELEMENT RECORD ID <br />El <br />E] Lagooning <br />❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br />Structure Operation Bird DIspO I <br />❑ ❑ 7. BurvinqAith 2" of Cover ® �� <br />❑ ❑ 8. A ro ed Concrete Tank <br />s <br />❑ ❑ 9. Re val from Premises 14-0 <br />Structure Operation Vec r Control <br />❑ ❑ 10. omestic FI <br />El 1 f Fannia Fly <br />0 <br />❑ ❑ 2. Larvae <br />❑ j 13. Pu ae <br />❑ ❑ 14. Adult <br />❑ ❑ 15. Li ht Population <br />❑ IZ 16. Moderate Population <br />❑ 17. Heavy Population <br />Structure fiperation FeedinglWater <br />❑ ❑ 18. Water Troughs <br />❑ ❑ 19. Cups or Bowls i <br />20. Food Storage <br />stn, re operation Houses <br />❑ 21. Floors 7 <br />❑ ❑ 22. Walls/Ceilings <br />❑ ❑ 23. Cleaning Fregena <br />7Structure Operation <br />❑ 1. Well Construction <br />10 Connection <br />Operetio <br />El <br />ProperlyGraded to Sewer <br />❑ ❑ .Drain <br />El❑ 5. Smooth/Cleanable <br />1:16. Covin <br />nin Frequency <br />Structure Operati <br />❑ ❑ 18. Smooth/Cleanable O <br />❑ ❑ in Frequency <br />Structure Operati C <br />❑El10. Condition <br />1:1 1:1itation <br />Structure Operation EOE! <br />El 12. Storage <br />El 3. Insect/Vermin <br />ure Op <br />Structure nimal Disposal <br />11❑ 14, emoval from Premises <br />❑ ❑ 15. Other <br />Structure Operation' -Sewage Disposal <br />❑El1 Septic System <br />E]❑ <br />Structure operation< Rabies Vaccinatio R EIVED UY + INS T R <br />❑ OU 44i. Certificate on Premises <br />VECTOR CONTROL INSPECTION FORM <br />EHD 40-06 4/6/12 Page —I Of <br />