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r <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ur x <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 /> ® p{g p� <br /> VECTOR COZY 1 INSPECTION FORM <br /> DBA ure OpINSPECT�fOf�DATE <br /> .s <br /> Structure / /® <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection 3.9--al O , <br /> Structure Operation Manure Mana eme tOWN R/OPERATOR PJOONE <br /> ❑ ❑ 3. Spreading and Di ing ; e <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> El El 5. Lagooning a S;;®2 7 0 2S <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DISpos I <br /> ❑ ❑ 7. Bu in th 2°of Cover <br /> ❑ ❑ 8. A rov d Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises J. <br /> Structure Operation Vect Control <br /> ❑ ❑ 10. jdomestic FI <br /> El 1:1 11 Fannia FI _1 <br /> ❑ ❑ Larvae <br /> ❑ ❑ A3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Po ulation <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure eration FeedingMater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Struc re Operation Houses <br /> in ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uen <br /> Structure Operation a el <br /> ❑ ❑ struction <br /> 2. gLoss Connection <br /> Structure Operation FOOr <br /> 87-15roperly Graded to Sewer <br /> ❑ ❑ 4. Drain `" _ ! .e <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> 7.-Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ ry e 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure operatio Ca <br /> ❑ ❑ ondition <br /> El El nitation <br /> Structure Operation FO <br /> ❑ ❑ storage <br /> 13. I <br /> Structure Operation nimal Di <br /> El ❑ 14. emova rom remises <br /> ❑ ❑ 5. <br /> Structure Operation ewage Disposal <br /> ❑ El - <br /> 16. a tic S stem <br /> 11 El Gu 17. Sewer <br /> Structure Operat o les VaCCi REC D BY INSPECTOR <br /> ❑ ❑ . Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />