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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> aq.. ;...;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> p� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA /30 INS PECTI N D TE <br /> Structure O ration /l/ <br /> 1:1 E] 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection--/— 3 <br /> Structure Operation Manure Mana eme OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis mg ( <br /> ❑ ❑ 4. Concrete Tanks INSP TION TYPE PROGRAM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning 41vs�v '��70 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Bu in 'th 2"of Cover ® �� <br /> ❑ ❑ 8. A r ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises ' <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> El 1A. Fannia Fly 1 <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht 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 /> strut re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings ` <br /> ❑ El23. Cleaning Fre uen <br /> Structure Operationrl <br /> ❑ ❑ <br /> Wellstruction <br /> El nnection <br /> Structure Operation <br /> Pro eri Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 11 7 n Frequency <br /> Structure Operation Walls <br /> ❑ C8. Smooth/Cleanable d <br /> ❑ ❑ 9. Qqaamg Frequency <br /> Structure Operation a <br /> ❑ I ❑ MO. Condition <br /> 1 ation <br /> Structure Operation <br /> ❑ ❑ . Storage <br /> El <br /> 13. <br /> Structure Operation "Animal DIRRpsat <br /> ❑ ❑ Removal from Premises <br /> ❑ ❑ 5. Other <br /> Structure Operation 1.sewage Disposal <br /> ❑ ❑ Se tic System <br /> ❑ ❑ . Sewer <br /> Structure Operati abieS VBCCinRECEIVED B INSPE TOR <br /> 1:1 El18. Certificate on Premises --T ±�' </� A,-,-< I <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page I of <br />