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SAN JOAQUIN COUNTY <br /> r yy ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �iFoaN <br /> 13%11 VECTOR CONTROL INSPECTION FORM <br /> DBA /1j� l, 1,Q/ C -7/� INSPEC OND T <br /> Structure O Sion e 1)LOQ h04'l v r^0 J� /0 S�7 r <br /> ❑ ❑ 7-7- <br /> PREMISE ADDRESS REaNSPECTIDN DATE <br /> ❑ ❑ 2 3' e Q a- 1 rZ <br /> Structure operation ern <br /> O�WNeER! PERATOR / HON G�(7 <br /> ❑ ❑ 3. Spreading nDiskng L-In rC C a�j�` q ©Jt�d_ 8A <br /> ❑ ❑ 4. ConcretVranks INSPECTION TYPE PROGRAM ELEMENT RE RD ID 'l <br /> El 5. Lagoo g tt. e An 1A5 &15 4 I <br /> ❑ ❑ 6. Com sting The items below represent code violations and must be corrected: <br /> Structure Operation Bird sposal <br /> ❑ ❑ 7. B/ying with 2"of Cover <br /> ❑ ❑ 8. bproved Concrete Tank � <br /> ❑ ❑ 9/Removal from Premises pV/{VL'1j tle- I/• <br /> k7 5 a oh A ~5 date n ot-e s <br /> Structure Operation ector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ 13. Pupae <br /> ❑ 14. Adult u l Z .S �� 11 G / 1 �� 1 ✓�G� S <br /> ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structu Operation Feeding/Water <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ 19. Cups or Bowls <br /> 20. Food Storage / <br /> S Operation Houses �" l ke a j I k tire- it - <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. WaIWCeilin s <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure operation Water Well <br /> ❑ ❑ 1. Construction r lX C�i� •J <br /> El 2. C ss Connection <br /> StructureOperation tiogri <br /> 3'IlPmperly Graded to Sewer <br /> ❑ 4. Drain (� Vic (")�/L- tll ecC <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> Cl El 7. Cleaning Frequency <br /> Structure Operation alls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> structure operation age <br /> 4Structune <br /> 10. Condition / issw 1 <br /> itation 1eration F❑ 12. Stora e <br /> 13. Insect/Vernin <br /> rucureperation Animal Dis Sal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> El1116.jrplic System <br /> ❑ EI17. Sewer <br /> tb � 'VakLL� <br /> Structure Oper9n b' accination RECEIVED B P CTOR � <br /> 11 El 18. Certificate on PremisesZ'1 b L' <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page / of <br />