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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 /> G�ppRN <br /> VECTOR CONTROL <br /> NTINSPECTION <br /> SpCCT ION C ®M <br /> EMSfiffaffEEM DBAINSPECTI DAT <br /> Structure Operation ,� �I®e <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 11 El 2. Cross-Connection--/— 177 3°C e. <br /> Structure Operation Manure Manageme t OWNER/OPERATOR PHONE <br /> 1:1 E] 3. Spreading and Di ing ex <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning zlel-I5—Y ® Y t(-t— <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DIspO I r P <br /> ❑ El7. Bu in ith 2-of Cover 2a ® J <br /> ❑ ❑ 8. A ro d Concrete Tank ` <br /> ❑ ❑ 9. Rem val from Premises <br /> Structure Operation Vect Control <br /> ❑ ❑ 10. jomestic FI <br /> 1:1 El 11 Fannia FI m <br /> ❑ ❑ 1j Larvae <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ j 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. HeM Population <br /> Structure o tion Feeding/Water <br /> ❑ ❑ 18. Water Troughs "'a p7 <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc <br /> Structure Operation at <br /> ❑ ❑ go t 1. Well Construction <br /> Cross Connection <br /> Structure Operation <br /> Properly Graded to Sewer 11 <br /> 11 ❑ Drain C — <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 9 <br /> 7. Cleaning Frequency <br /> Structure Operation IS <br /> ❑ ❑ Smooth/Cleanable <br /> ❑ qE01- <br /> nin Frequency <br /> Structure Ca <br /> ❑ 0. Condition <br /> it. Sanitation <br /> Structure O <br /> ❑ . Stora e <br /> El 3. Insect/Vermin <br /> Structure Operatf Animal Disposal <br /> ❑ ❑ 4 Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ septic system <br /> ❑ ❑ <br /> Structure operatioC Rabies Va REE E Y INSP TO <br /> ❑ ❑ Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EH <br /> D 4G-06 4/6/12 i Page Of <br />