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SAN JOAQUIN COUNTY • <br /> rENVIRONMENTAL HEALTH DEPARTMENT <br /> `2< <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �IFOR <br /> f�7 L/U VECTOR CONTROL INSPECTION FORM <br /> DBA �,�jI/ INSPE ION DX�C <br /> Structure Operation ��-i G� Q <br /> ❑ ❑ 1. Well Construe on PREMISEADDRESS <br /> ^ RE-I SPECTION DATE <br /> 1:1IS <br /> ❑ 2. Cross-Conn ction :_6 V _kltl K4• , c1qu <br /> Structure Operation Manure Mariagement OPERATOR ^ PHONE <br /> 1336 y L16❑ 3. Spreadin and Disking 11 G l/,' � <br /> ❑ ❑ 4. Concre Tanks PEC TI N TYPE PROG T RECORD ID <br /> E] ❑ 5. Lago ing 2 61tutojl�trr1)C <br /> ❑ ❑ 6. co posting The items below represent code violations and must be corrected: <br /> Structure Operation Bir DiSPOSaI <br /> ❑ ❑ 7/B.rying with 2"of Cover <br /> ❑ ❑ 4_Approved Concrete Tank <br /> ❑ ❑ j 9. Removal from Premises <br /> Structure operation/ vector control _ <br /> El 0 / 10, Domestic FI hito <br /> ❑ 11. Fannia FI <br /> ❑ 12. Larvae <br /> ❑ 9 13. Pupae �.. <br /> 14. Adult <br /> El ElC. emmypt QAV( <br /> ❑ ❑ 15. Light Population p�/� � <br /> El 1116. Moderate Population V OA, <br /> ❑ ❑ 17. Heavy Population �� p <br /> Stru a Operation Feeding/Water 2-), <br /> ❑ 18. Water Troughs <br /> ❑ 19. Cups or Bowls ° <br /> ❑ ❑ 20. Food Storage ►�/� <br /> tructure Operation Houses 3 00V AP- <br /> r' ❑ ❑ 21. Floors <br /> El El _�S <br /> 22. Walls/Ceilings n <br /> ❑ ❑ 23. Cleaning FrequenevX 1111111111 _ = / ors <br /> do e P�d * �* e <br /> Structure Aeration Wa ell �/ L ^ !` <br /> ❑ ❑ 1 onstruction ` <br /> 0 If 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 3. Proped Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ j0peration <br /> 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> ❑ P. CleaningFrequency <br /> StructurWalls <br /> ❑ 8. Smooth/Cleanable <br /> ❑ 9. Cleanin Fre uencStructurCages <br /> 10. Condition <br /> ❑ 1 itation <br /> Structuood <br /> ❑ -.,.5e <br /> El 13. Insec ermin <br /> structun Animal D s oral <br /> ❑ ❑ 14. R9468val from Premises <br /> ❑ ❑ 'Othe <br /> Structure Operation .Stwao Disposal <br /> ❑ ❑ tic System <br /> ❑ 17. Sewe <br /> stn, r o e on Rabie accination R CEIVE(p-BY IN TOR <br /> ❑ El . Certificate on Premises l -. <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page of <br />