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�o�'°U�N••.co SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 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 /> �IFOtRI� ® �® <br /> VECTOR CONTINSPECTION FORM <br /> slim IffffiffiffffillINEM DBA INSPECT ON DATE <br /> Structure Operation S A ��® �J -- <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> El El2. Cross-Connection de, 7a3/ <br /> Structure Operation Manure Mana erne OWNERIOPERATOR PHONE ) <br /> 11 E] 3. Spreading and Di ing Cp® . �' ( 4* 7e2 7- ,?Ir <br /> ❑ ❑ 4. Concrete Tank INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning of IV S_L/ {" <br /> ❑ ❑ 6. Compostingt The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. Bu in with 2"of Cover <br /> ❑ ❑ 8. Appr ed Concrete Tank <br /> r <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve or Control <br /> ❑ ❑ 119. Domestic FI <br /> t. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population Fare- <br /> 0 <br /> e <br /> ❑ ❑ 17. HeavyPopulation <br /> Structure peration Feeding/Water <br /> ❑ ❑ 18. Water Troughs Irao <br /> /, <br /> ❑ ❑ 19. Cu s or Bowls <br /> 20. Food Stora e <br /> Struc re Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Fre uenc <br /> Structure Operation Water Well <br /> ❑ [3nV 1. Well Construction ^� <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> 3. Property Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/CleanableEl .1 ,176. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ A 0. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 2. Storage <br /> 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ A 4. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ - 0_t,16. Se tic System <br /> El 17. Sewer <br /> Structure Operation Rabies Vaccination EIVE INSPECTOR <br /> El El8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> l Page_of <br />