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�Q4`'•" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 4'. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • c°<<> oR�;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPEC71O�N QATE <br /> Structure Operation Water Well I <br /> ❑ ❑ 1. Well Construction PREMISE ADDRE S RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3- r2-1 �- <br /> Structure Operation Manure Mana erne OWNEPJOPERATOR PHONE ^� <br /> El ❑ 3. Spreading and Dis Ing "'e[- '/<*�/ �� (20,f) �.X <br /> )g "A&A24 <br /> ❑ ❑ 4. Concrete Tanks INSPEPFTION TYPE �J PROGRAM ELEMENT RECORD ID �^ <br /> 1:1 ❑ 5. Lagooning '?^-t 7/hGc c-��-2 �qs k ®��7 ® -?J <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Burying ith 2"of Cover /`"""►'�"e �`� <br /> ❑ ❑ 8. A ro d Concrete Tank 00 <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vect r Control <br /> ❑ ❑ 10. omestic FI <br /> 14. Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ El 16. Moderate Population v <br /> ❑ 17. Heavy Population <br /> Structure 0aration Feeding/VVater e <br /> ❑ ❑ 18. Water Troughs ,_ g p�c a i^ 7t C.�✓ !��� Cf�,,��. ,may, f f <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struct a Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleanin Fre uenc �� <br /> girt- <br /> Structure Operation •W <br /> ❑ ❑ 1. Well Construction <br /> El 2. Cross Connection <br /> Structure Operatic Flo S <br /> roperly Graded to Sewer <br /> ❑ ❑ 1,, 4. Drain <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> 07. CleaningFre uencStructure Operatio❑ ❑ h/Cleanable <br /> ❑ ❑ Fre uenc <br /> Structure Operation Ca S <br /> ❑ ❑ ondition <br /> 11. tation <br /> Structure Operation ood <br /> ❑ ❑ tora e <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. e <br /> Structure Operation abies Vaccination RECEIVED BY INSPECTOR / <br /> ❑ Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page/Of <br />