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'oAquI,N,,Co SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ur x <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<F ORS <br /> VECTOR <br /> CONTROL <br /> NTL SryECTION FORM <br /> DBAINSPECTIO DTE <br /> 12 Structure OperatiogFn - <br /> ❑ ❑ 1. Weil ConstructionPREMISE ADDRESS RE-INSPECTION DATE <br /> El 2. Cross-Connection4 s-/ r <br /> Structure Operation Manure Mana eme t OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Di ing '9)3-23- ? 7 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning J 00A4° S <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispofAl <br /> ❑ ❑ 7. Bu in ith 2"of Cover <br /> ❑ ❑ 8. Approy6d Concrete Tank <br /> ❑ ❑ 9. Rem val from Premises <br /> Structure Operation Vect Control <br /> ❑ ❑ 10. korne.tic FI <br /> 11 Fannia FI <br /> ❑ ❑ 1 . Larvae '� l <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population e <br /> ❑ 10 17. Heavy Population <br /> Structure Op/ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storacie <br /> Structuri Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings I� <br /> ❑ ❑ 23. Cleanin2 Fre uenc <br /> Structure Operation Water Well -� <br /> ❑ ❑ CA 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors s <br /> a--properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 11 6. Covin <br /> El 0 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ & Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ t10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 3. insectivermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 6. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED BA IN P CTOR <br /> ❑ 18. Certificate on Premises <br /> 'tel <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page )of <br />