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SAN JOAQUIN COUNTY <br /> _ ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •meq.• .N;c• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> /FOR ® CONTROL <br /> ® �® <br /> VECTOR CONTR L S ECTION FORM <br /> DBAINSPEC ION DA�TEE <br /> Structure Operation +"+ -711f <br /> ❑ ❑ 1. Well ConstructionPREMISE ADDRESS Z7 RE-INSPECTION DATE <br /> 1:1 ❑ 2. Cross-Connection Z/rq j? 4�4 /2, <br /> Structure Operation Manure Mana em It OWNERIOPERATOR PHONE <br /> ElF] 3. Spreading and Di ing —033 f4 <br /> ❑ ❑ 4. Concrete Tank'' INSPECTION TYPE OGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning �f <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispgial <br /> ❑ ❑ 7. Burving4ith 2-of Cover <br /> ❑ ❑ 8. Apprq4d Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve or Control <br /> ❑ ❑ 1 Domestic FI <br /> 1. 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 peration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct re Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation 19ater 1k ,_ <br /> ❑ ❑ Well Construction <br /> Cross Connection <br /> Structure Operation O <br /> El El Properly Graded to Sewer s <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El 6. Covin <br /> 7. Cleaning Frequency ,— e <br /> Structure Operation a <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 4jV9. Cloninggloning Frequency <br /> Structure Operation ages <br /> ❑ ❑ . Condition <br /> El itation /, <br /> Structure Operation FOO <br /> ❑ ❑ 2. Storage <br /> El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 1 Removal from Premises <br /> ❑ ❑ IV, 15. Oth <br /> Structure Operation. Wa a D' <br /> ❑ ❑ Se tic System <br /> 1:1 E] 17. S <br /> Structure Operation frables Vaccinatio. IVE SP C OR i <br /> l —f <br /> ❑ ❑ erti icate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of f <br />