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o¢a"'" • SAN JOAQUIN COUNTY <br /> `y ENVIRONMENTAL HEALTH DEPARTMENT <br /> to.* _ 4 <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <IFOK <br /> I .- a0,2SagVECTOR CONTROL INSPECTION FORM <br /> DBA �7 -�•y� �t,� �t e• INSPECTION DATE <br /> Structure Operation +�C.°� Itis d• `t.v� <br /> ❑ ❑ 1. Well Constructi n PREMISE ADDRESS RE-INSP CTION ATE <br /> ❑ ❑ 2. Cross-Conne on 0 J �� -/ 1 v ����y rC <br /> Structure Operation Manure Manahernent OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading dDisking1 ('e- <br /> ❑ ❑ 4. Concrete fanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooni "�i ug U o J <br /> ❑ ❑ 6. Compo ting The items l5elow represent code violations and must be corrected: <br /> Structure operation Bird Di posal <br /> ❑ ❑ 7. Budna with 2"of Cover <br /> ❑ ❑ 8. Apiroved Concrete Tank <br /> ❑ ❑ 9. FAmoval from Premises P a 'Lt r 00 6U2 irl E Z l i � <br /> Structure Operation Ve for Control I Ll <br /> El ❑ 1 Domestic FI III {}tel ) 5 e r r;7 I�jFZ r,C OF l711 07A / e/fulp-0 <br /> ❑❑ fl. Fannia Flya hI k e 1n e I• c� QE1 a S are -10ha I!� �0,A <br /> ❑ 12. Larvae 1 <br /> ❑ ❑ 13. Pupae (/� , <br /> 1:10 14. Adult 1 rT/ ii-t rab;L S L a o�'(or f on y e . <br /> ❑ ❑ 15. Li ht Population �7 �t r <br /> El 0/ 16. Moderate Population a d V ht6l ^ ao;mais 1 a n lft a V/,•t e <br /> ❑ 17. Heavy Population <br /> ❑ ❑ �1 I- <br /> Structure op ration Feeding/Water 'in 1 ver <br /> C <br /> yfrII i V I L i /f LIl lsVI/Lt, <br /> V <br /> �C1�0 <br /> 18. Water Troughs C _ <br /> 11 ❑ 19. Cups or Bowls hCevl n <br /> 1120Food Storage r <br /> Structure Operation Houses nQwo aivme Owner, Pipr Ali( & <br /> El 21. Floors <br /> 1-1 El F-1 1 22. Walls/Ceilings Ar+ . & OW " <br /> � I <br /> �S <br /> ❑ Af <br /> 23. Cleaning Fre uenc r ��0 ,!1„ `��1 1_ , p (^ I O�•C r'l10 0 <br /> Structure Operation Water Well . [Jl(� 'l�y�C J <br /> El ❑ 1. Well Construction ( o- -s Haat e /n cd en � <br /> d <br /> r <br /> 11E] 2. Cross Connection <br /> Structure Operation Floors lvrL �iaV1 �r-e iSt Provide <br /> �� <br /> ❑ <br /> ❑ 1 3. Properly Graded to Sewer <br /> 11 4. Drain t r al of' <br /> rv <br /> CAI am V t C(at e� <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El [:1 6. Covin cw / -zn )�r Y-0-61-es <br /> F r <br /> ❑ ❑ 7. Cleaning Frequency �t� <br /> Structure Operation Walls r•e� t'n o 1,/11,s MQ("S) <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System L, <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination K EIV „ IN ECTOR <br /> ❑ ❑ 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page_of <br />