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l <br /> SAN JOAQUIN COUNTY <br /> 2 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 /> <<F Ottt� p� ®p� <br /> VECTOR CONT SECTION FORM <br /> DBA d INSPECTI7%1D TE <br /> Structure Operation d / <br /> ❑ ❑ 1. Well Construction PRE/MISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-connection / 73� `'� <br /> Structure Operation Manure Mana eme OWNER/OPERATOR V V P ONE <br /> El ❑ 3. Spreading and Dis ng W-Y-.2`7 <br /> ❑ ❑ 4. Concrete Tanks INSIDE TION TYPE V PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning g fA G�y <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Bu in h 2°of Cover f <br /> ❑ ❑ 8. ApprovAConcrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation vect0 Control <br /> ❑ ❑ 10. omestic FI <br /> El n 11. annia FI <br /> ❑ ❑ 11 Larvae <br /> ❑ ❑ 3. Pupae <br /> El El 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure o rasion Feeding/Water <br /> ❑ ❑ 18. Water Troughs - ®, <br /> ❑ ❑ 19. Cups or Bowls `® <br /> Lj 20. Food Stora e <br /> Struct Operation Houses <br /> Ex ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre gen <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection �N <br /> Structure Operation Floors ® ®( <br /> 3. Pr0DerIv Graded to Sewer <br /> ❑ ❑ W4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ El 6. Covin <br /> 1:1 F1 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑Q rA. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ Aj 12. Storage <br /> 3. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑In e tic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation 1 R bies VaccinationR DAY INSPECTOR <br /> 1:1 El18. Certificate on Premises <br /> /,&j� Az�-, <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />