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SAN JOAQUIN COUNTY <br /> r' ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: y< <br /> :. 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> phi <br /> P f Pcl r j VECTOR CONTROL INSPECTION FORM <br /> DBA i /� ly RE ION DATE <br /> Structure Operation {. 1 T La r(J18 zo <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS6 d 1/ RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection / ''° _rrC C( /V <br /> Structure Operation Manure Management OWNER/OPERAT R I r <br /> PHONE <br /> El El 3-3. Spreaging and Disking12� Q <br /> S Q 3.5-(P <br /> ❑ ❑ 4. Cong ete Tanks INSP ON TYPE _ PROGRAM ELEMENT DID <br /> El E] 5. Lagooning C q -s- ® Oa 53 <br /> ❑ ❑ 6. Qomposting The items below represent code violations and must be corrected: <br /> Structure Operation B' d Disposal <br /> ❑ ❑ ). Bu in with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank ��� u ,J <br /> ❑ ❑ 9. Removal from Premises U�l(.tnMT ru) <br /> Structure Operati9r1 Vector Control i <br /> 11 ❑/ 10. Domestic FI I I0 to }-,(,Vv <br /> ❑ 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> El _E1 14. Adu to d n <br /> ❑ ❑ 15. Light Population /}� �f <br /> El El 16. Moderate Population { h �lV r O 1. l di-1 a L <br /> ❑ ❑ 17. Heavy Population „ ► U v tXt � C) 1 1 e <br /> Structu� Operation /W <br /> Feedingater 'IV, T -C',J / `rKX <br /> Q+ ❑ 18. WaterTrou hs G - <br /> 14 - ❑ 19. Cups or Bowls <br /> ❑ 20. Food Storage j I ® p ' � 11 <br /> Structure Operation HOUSQS "�' �J V <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ 1 ❑ 23. Cleanin Fre fent <br /> Structure Operation JAWParNfill <br /> ❑ ❑ P <br /> ell Construction <br /> ❑ ❑ ss Connection <br /> Structure Operation❑ ❑ roped Graded to Sewer <br /> ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ 7. Agoning Frequency <br /> StructurI <br /> n *5-1 Is <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9.-Cleaning Frequency <br /> Structurn S <br /> ❑ 10. Condition <br /> 1 nitation <br /> Structurn❑ 12. Stora e <br /> 13 t(vermin <br /> Structuron nitpa iS osal <br /> ❑ ( 14. Removal from Premises <br /> ❑ 1 Oth'Structureon a Disposal C, <br /> ❑ ❑ 16._Septics stem J <br /> El ElN Y "1%P <br /> S er ,.u� '7 <br /> Structur 'f perkion les Vaccination R C IVED BY T <br /> ❑ ❑ 18. Certificate on Premises h I <br /> VECTOR CONTROL INSPECTION FORM / <br /> EHD 40-06 12/04/08 / <br /> Page_of_ <br />