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PQu,n, SAN JOAQUIN COUNTY <br /> _ y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • Cq.• >� �P• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> <hi Oma <br /> VECTOR p� p� <br /> CONT INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation . 71,711-3 <br /> ❑ ❑ 1. Well ConstructionPREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-connection 13 7 <br /> Structure Operation Manure Mana eme OWNERIOPERATOR PHONE <br /> 11 E] 3. Spreading and Dis ng 1fy-� ) Y_P_ <br /> 1:1 E] 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DisposAl <br /> ❑ ❑ 7. Bu in ith 2"of Cover <br /> ❑ ❑ 8. ApproAd Concrete Tank <br /> f <br /> ❑ ❑ 9. Re vai from Premises <br /> Structure Operation vectAr Control <br /> ❑ ❑ 10. Domestic FI <br /> El 14. Fannia Fly ,�°� <br /> ❑ ❑ 2. Larvae - <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population f� <br /> ❑ 17. Heavy Population <br /> Structureration Feeding/Water <br /> El ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowl X 74) <br /> 1:1 El 20. Food Storage <br /> Structyie Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings ' <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation ater P <br /> ❑ ❑ 1. Well Construction r �' <br /> El 2. Cross Connection <br /> Structure Operation FIOor <br /> 1;r.-Properly1;r.-Properly Graded to Sewer <br /> ❑ ❑ LUC4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin �M <br /> 7. Cleaning Frequency <br /> Structure Operation I wa Is <br /> ❑ ❑ n 8. Smooth/Cleanable <br /> ❑ ❑ 9. CleaningFrequency <br /> Structure Operation ages <br /> ❑ ❑ ondition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> El El 13. Inge <br /> Structure Operation nimal DlS osal <br /> El 11va rom Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation wage Disposal <br /> ❑ ❑ e tic S stem <br /> ❑ ❑ 17. S <br /> Structure Operation abies Vaccinatio CEIVE BY INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises `C <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_L of <br />