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SAN JOAQUIN COUNTY 10 <br />z rJ ? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />VECTOR CONTROL INSPECTION FORM <br />Structure <br />Operation <br />DBA j'"`� <br />/" <br />INSPECTIO DATE <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESS <br />0c3 af-1,4x/ <br />RE -INSPECTION DATE <br />❑ ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Mana em t <br />OWN OPERATOR V <br />PJiONE ) <br />f --/),2 %.f - O'C.?y <br />11 El 3. Spreading and Doing <br />❑ <br />❑ <br />4. Concrete Tank <br />INSPECTION TYPE <br />PROGRAM ELEMENT <br />V' S <br />RECORD ID <br />c V 9".; 0 ,j�' <br />❑ ❑ 5. Lagooning <br />❑ <br />❑ <br />6. Compostin <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird DIspO al <br />® �- <br />❑ ❑ 7. Bu in ith 2" of Cover <br />❑ <br />❑ <br />8. ApprQ4ad Concrete Tank <br />❑ ❑ 9. Re oval from Premises <br />structure <br />Operation <br />veefor Control <br />17 <br />❑ ❑ 1 Domestic FI <br />1. Fannia FI <br />F 1� 2 <br />E] El 12. Larvae <br />❑ <br />❑ <br />13. Pu ae <br />❑ ❑ 14. Adult <br />❑ <br />15. Light Population <br />_ <br />❑ 16. Moderate Population <br />❑ <br />❑ <br />17. Heavy Population <br />Structure Operation Feeding/Water <br />❑ <br />❑ <br />18. Water Trou hs <br />r <br />®1� <br />❑ ❑ 19. Cups or Bowls <br />20. Food Storage <br />Stru re Operation Houses <br />❑ <br />21. Floors <br />; f <br />❑ ❑ 22. Walls/Ceilings <br />❑ <br />❑ <br />23. Cleanin Freuenc <br />Structure <br />Operation <br />Ovate <br />r� <br />❑ ❑ 1. Well Construction <br />2. Cross Connection <br />Structure Operation Oor <br />El <br />L-ieri <br />Graded to Sewer <br />_ <br />POI A42 <br />❑ ❑k14 4. Drain <br />❑ <br />❑ <br />5. Smooth/Cleanable <br />11 El 6. Covin <br />El <br />11 <br />Ing Frequency <br />StructureOperatio Wa <br />El❑ <br />8. Smooth/Cleanable <br />El El ing Frequency <br />Structure <br />Operatio <br />Cages <br />❑ ❑ 10. Condition <br />El <br />tation <br />Structure Operation F000 <br />❑ <br />❑ <br />Storage <br />13 <br />Structure <br />operation <br />Animal Dis <br />❑ ❑ 14. Removal from Premises <br />❑ <br />❑ <br />15. Other <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />Septic System <br />❑ ❑ 17. Se <br />Structure <br />Operatio <br />abies Vaccination <br />RECEIVED BY <br />INSP O <br />❑ ❑ Certificate on remises <br />VECTOR CONTROL INSPECTION FORM " <br />EHD 40-06 4/6/12 <br />Page I of <br />