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SAN JOAQUIN COUNTY <br /> : ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q., «� �P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:WWW.sjgov.org/ehd <br /> �/PORN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA (NSP �O®QAI <br /> Structure Operation / <br /> ❑ ❑ 1. Well Construction PREMISEADDRE RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana eme OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ng �✓ 17 yw�^ 3�5� <br /> ❑ ❑ 4. Concrete Tanks INSP TION TYPE PROGRAM L MENT R RDD f� <br /> 13 [:] 5. Lagooning7 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dlspos I <br /> ❑ ❑ 1 7. Burying th 2°of Cover <br /> ❑ ❑ 8. A rov d Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation Vect Control 617 <br /> ❑ ❑ 10. omestic FI <br /> 11 Fannia FI -� <br /> ❑ ❑ . Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ Ey 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure O eration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Stora e r <br /> Structur Operation Houses <br /> EY 1:121. Floors <br /> 1:122. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> r <br /> Structure Operation QLate <br /> ❑ ❑ rlff. Well Construction <br /> Cross Connection <br /> Structure Operation <br /> ❑ ZZ.:fEo::&rIy Graded to Sewer <br /> ❑ ❑ 4 Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7.-geaning Frequency <br /> Structure Operation <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operatio ge <br /> ❑ ❑ 0. Condition <br /> 4,1,,Sanitation <br /> Structure Operation F r <br /> ❑ ❑ —Storage <br /> 13. insectivermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> 1:1 ❑ 1 r <br /> Structure Operation Sewage Dispqsil <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. <br /> Structure Operation abies Vaccinatio R D BV XINSP C O <br /> ❑ ❑ VL . Certificate on Premises Al <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page ) of <br />