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SAN JOAQUIN COUNTY <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> L <br /> 1868 East Hazelton Avenue, Stockton, California 95205-62.32 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ur:oR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTI DAT, <br /> Structure Operation �(1// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS / RE-INSPECTION DATE <br /> El 2. Cross-Connection 6�s-1 4 Aw V <br /> Structure Operation Manure Mana em t OWNER/OPERATOR P ONE <br /> ❑ ❑ 3. Spreading and Di ing t124W,1 3;7_?- '7 f'®7 <br /> ❑ ❑ 4. Concrete Tank INSPEC ION TYPE PROGRAM ELEMENT <br /> RECORDID <br /> ❑ ❑ 5. Lagooning h C e�2e�ct� ��� �irG io ���'�' <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispgfial <br /> ❑ ❑ 7. Bu in with 2'of Cover <br /> ❑ ❑ 8. A r ved Concrete Tank , <br /> ❑ ❑ 9. R oval from Premises r <br /> Structure Operation ve or control <br /> ❑ ❑ 1 Domestic FI <br /> 1. Fannia FI <br /> ❑ ❑ 12. Larvae P7 . <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ EY 15. Li ht Population <br /> ❑ 16. Moderate Population .N <br /> ❑ 17. Heavy Population <br /> Structure Operation FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct Operation Houses r' A� <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency e <br /> Structure Operatic, Vater W <br /> ❑ ❑ ell Construction <br /> 2. Cross Connection <br /> Structure Operation Wooig, <br /> _-3-15-roperly Graded to Sewer <br /> ❑ ❑ D 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin ®� <br /> Cleaning Frequency <br /> Structure Operatic, Wal <br /> ❑ ❑ . Smooth/Cleanabie <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation "Cap <br /> ❑ ❑ 10. Condition C <br /> 1. Sanitation <br /> Structure Operation OO <br /> ❑ ❑ tora e <br /> El 13. Insect/Vermin <br /> Structure Operation iS os I <br /> ❑ ❑ va from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 1 <br /> Structure Oper bies Vaccination~ RECEIVED BY t INSPE TOR <br /> E] ❑ 18. Certificate on Premises t <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />