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,e �guy...�o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • q., ;:N;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR <br /> VECTOR CONTROL SECTION FORM <br /> DBA INSPECT OND TE <br /> Structure Operation 791111 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> El El 2. Cross-Connection 3?lo Pucr <br /> Structure Operation Manure Managenteut Ow OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ng <br /> ❑ ❑ 4. Concrete Tanks (NSP TION TYPE PROGRAM ELEMENT RECORD ID <br /> El E] 5. Lagooning 1_Z/ /O f <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo l <br /> ❑ ❑ 7. Bu inqAith 2"of Cover � <br /> ❑ ❑ 8. A r ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> 1f. Fannia Fly7 <br /> 1:1 El2. Larvae ' a- <br /> 3. <br /> ® 't <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ U 16. Moderate Population ®� <br /> ❑ 17. Heavy Population <br /> Structure ration Feeding/water <br /> ❑ E] 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Strutt a Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ji _ <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure TOpe�ratlonater w❑ 1. Well ConstructionEl 2. Cross ConnectionStructure Floor <br /> El 3. Pro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable -� <br /> El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation ails <br /> ❑ ❑ Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation ages <br /> ❑ ❑ 0. Condition <br /> 11. nitation <br /> Structure Operation -Food <br /> ❑ ❑ --storage <br /> 1:1 Ej 13. insectivermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. h <br /> Structure Operation< Sewage Dis <br /> ❑ ❑ 6. Se tic S stem <br /> Structure Operati9j Rabies Vaccin R FIVE INSPECTOR <br /> ❑ El Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />