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SAN JOAQUIN COUNTY <br />r z ENVIRONMENTAL HEALTH DEPARTMENT <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 />ft*- C, POO 736113 VECTOR CONTROL INSPECTION FORM <br />Structure <br />Operation <br />DBA, /� '#� <br />O L " / l t J I rI 0 <br />i - <br />! �1 <br />INSPEC N DAT <br />❑ <br />❑ <br />1. Well Construction <br />PREMISE ADDRESSL_ <br />,� , -1)C)9,4,s <br />RE -INSPECTION DATE <br />11L ❑ 2. Cross -Connection <br />Structure <br />Operation <br />Manure Managemont <br />OWNER/OPERA OR / <br />�� C a -t 0) C'. �7 �7 <br />HON <br />L <br />/(�,� =131-10115- <br />❑ ❑ 3. Spreading and .king <br />❑ <br />❑ <br />4. Concrete Tans <br />INS CTION TYPE <br />L 1 / �ti <br />PROGRAM ELEMENT <br />L <br />I - <br />RE RD I(D� <br />%� a 0 l wo6;q- <br />C]5. Lagoonin9 <br />❑ <br />❑ <br />6. Compos ' g <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird DI oral <br />❑ ❑ 7. Bury(nq with 2" of Cover <br />❑ <br />❑ <br />8. roved Concrete Tank <br />❑ ❑ 9. emoval from Premises <br />Structure <br />Operation <br />ector Control <br />❑ ❑ 10. Domestic FI <br />11 <br />11. Fannia FI <br />❑ ❑ 12. Larvae <br />! . ( �e/( V C <br />/ • (� U ar <br />l�"�� %'/�/1/ <br />El 14. Adult <br />❑ <br />❑ <br />15. Light Population <br />��?? oil <br />(L �� o {� <br />�� % �l ' <br />d <br />El❑ 16. Moderate Population <br />❑ <br />❑ <br />17. Heavv Population <br />Structuryf Operation Feeding/Water <br />❑ <br />18. Water Troughs <br />O " / t�� '/ ` -� acherieaiA <br />l <br />Q o ll �t <br />❑ 19. Cups or Bowls <br />20. Food Storage <br />cture Operation Houses <br />❑ <br />❑ <br />1 21. Floors <br />❑ ❑ 1 22. W,11,/Ceilings <br />❑ <br />Structure <br />❑ <br />Operation <br />23. Cleaning Frequeric <br />Water Well <br />��� �� � t�1.0 d �-S <br />C'SCl.-r = <br />❑ ❑ 1 struction <br />2. Cross Connection <br />Structure Operation <br />E�pe❑ d Graded to Sewer <br />, �/�' In <br />t/ll t/ 1 <br />I ,, c n �� <br />• l t <br />❑ Drain <br />❑ <br />❑ <br />mooth/Cleanable <br />❑ Covin <br />7. Cleanin5-Erequency <br />Structure Operation Walls ilymaty <br />❑ <br />8. Smooth/Cleanable <br />, <br />�� �� *.0 L (- S , <br />❑ ❑ 9. Cleaning Frequency <br />Structure <br />Operatio <br />ages, <br />❑ Q ❑ . Condition <br />11. Sanitation <br />( r <br />C) / l l ' �`( c' i ( <br />/'I, CI -f� c . <br />Structure Operation Food <br />13. Insect/Vermin <br />Structure <br />o eretion <br />Animal Dis oral <br />❑ ❑ 14 emoval from Prem' <br />❑ <br />❑ <br />15. Other <br />Structure Operation Sewage Disposal <br />❑ <br />❑ <br />System <br />//��1 �( / / <br />a �./ til c9 / (rCJ �! <br />❑ EI 17. Sewer <br />Structure <br />Fpperition <br />I Vaccination <br />RE IVE . <br />/ <br />1 PECTO <br />r <br />❑ 418 tate on Premis <br />VECTOR CONTROL INSPECTION FURW- / <br />EHD 40-06 12/04/08 l <br />Page - of _ <br />