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,��```'''" •so SAN JOAQUIN COUNTY <br /> a � ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> up { <br /> F. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> q..• ;P Telephone.(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> OR p® <br /> VECTOR® CONTROL INSPECTION FORM <br /> DBA INSPECT N ATE <br /> Structure Operation k <br /> ❑ ❑ 7Spreadingn <br /> uction PREMISE ADDRESS RE-IN PECTION DATE <br /> ❑ ❑ ection 1 3 <br /> Structure Operation a em t OWNE OPERATOR PHONE <br /> ❑ ❑ . and D' king AE J3„� 202 y <br /> ❑ ❑ 4. Concrete Tan INSP TION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning -11413-q 84 05Ve6 Yd <br /> ❑ ❑ 6. composti g The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis sal <br /> ❑ ❑ 7. Bu i with 2-of Cover <br /> ❑ 1 ❑ 8. Ap oved Concrete Tank <br /> ❑ ❑ 9. moval from Premises ® , <br /> Structure Operation V for Control <br /> ❑ ❑ 16. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae S p <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Aeration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Stru#iure Operation Houses <br /> Al ❑ 21. Floors <br /> 1 <br /> El 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure operationater w <br /> ❑ ❑ 1. Well Construction <br /> El El 2. Cross Connection <br /> Structure Operation tfloorp <br /> Pro ed Graded to Sewer <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 1:1 El 6. Covin <br /> El El 7.=Q1eaning Frequency <br /> Structure Operation I W <br /> ❑ ❑ 8. Smooth/Cleanable 4/0 <br /> ❑ ❑ 9._Qleaning Frequency ~c�rz <br /> Structure Operation C <br /> ❑ El ;-W. Condition <br /> Sanitation <br /> Structure Operation FOO <br /> ❑ ❑ Stora e <br /> 13. insectivermin <br /> Structure Operation -Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 1 15. <br /> Structure Operation ewage Dispos <br /> ❑ ❑ isstem <br /> ❑ ❑ 17. <br /> Structure Operatio abieS Vaccinati CEIVE BY INSPECTOR <br /> ❑ i ica a on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />