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SAN JOAQUIN COUNTY <br /> -.� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> <<FOR <br /> VECTOR <br /> /1 ryC�4 FORM®n� <br /> VECTOR CONT SECTION FORM <br /> lffifflufflafflM DBA <br /> INSPEC ION DTE <br /> Structure Operation ® ® j <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 1:1 El 2. Cross-Connection <br /> Structure Operation Manure Manage OWNER/OPERATOR P}10N ® <br /> El E] 3. Spreading and Di ing a` J q 9e <br /> ❑ ❑ 4. Concrete Tanks INSPAPTION TYPE PROGRAM ELEMENT RECORD ID <br /> `7 <br /> ❑ ❑ 5. Lagooning - Ae 0"' <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dlsp al <br /> ❑ ❑ 7. B.rvinVith 2-of Cover <br /> ❑ ❑ 8. A r ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises ' <br /> Structure Operation Ve or Control <br /> ❑ ❑ 1V Domestic FI <br /> 1. Fannia FI Is$ <br /> 1:1E0112. Larvae <br /> ❑ ❑ A 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ EY 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. HeavyPopulation <br /> Structure Operation FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Sir ure Operation Houses <br /> ❑ 21. Floors -a- ®. <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleanin Fre uenc <br /> Structure OperationM2.S±LG�onnection <br /> ❑ ❑ nStructure Operation <br /> ❑ -97-Properly-97-ProperlyGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable F <br /> ❑ 6. Covin <br /> El 7. Cleaning Frequency <br /> Structure Operationnyaw <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 18--Gleaijinq Frequency <br /> Structure Operation C139901-1 <br /> ❑ ❑ ;d 10. Condition 1pa <br /> tAr <br /> 1:1 El nitation <br /> Structure Operatic F660 <br /> ❑ ❑ 2. Stora e <br /> El 3. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation ewa a D' <br /> ❑ ❑ 16. Se tic S stem <br /> ❑ ❑ 17. Sew <br /> Structure operatignLI Rabies Vaccinatil) REC B INS ECTO <br /> ❑ ❑ aeon Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page , Of <br />