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PP_ <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax. (209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR CONTROL INSPECTION FORM <br /> fffilffiffJOEMEM DBA INSPEC2p DA <br /> Structure Operation Water Well <br /> El 11 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> Ej El 2. cross-connection /1417CS- <br /> Structure Operation Manure Managerriefit OWNEFYOPERATOR BHONE <br /> El El 3. Spreading and Vking e-C tl 20$Pj -31 <br /> 1:1 [:] 4. Concrete Tan' INSPECTFN TYPE PROGRAM ELEMENT RECORDID <br /> El [:] 5. Lagooning/ 7.,c k�" 1 /'k <br /> 11 171 6. CompostiIiig The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis Osal <br /> El 0 7. Buryjgwith 2'of Cover <br /> 8. Apl(roved Concrete Tank <br /> 9. 0 moval from Premises <br /> Structure Operation V 2-6tor Control <br /> El El A. Domestic Fly <br /> E] 111. Fannie Fly <br /> El ❑ 12. Larva <br /> 1:1 ❑ 13. Pupae <br /> 0 El 14. Adult <br /> C1 F'r 15. Light Population <br /> 1:1 16. Moderate Population <br /> 11 El 17. Heavy Population <br /> Structure AperatEion Feeding/Water <br /> r, <br /> El El 18. Water Troughs <br /> 1:1 El 19. Cups or Bowls <br /> E] M _20. Food Storage <br /> Stru re Operation Houses <br /> El 21. Floors I/ <br /> ❑ 22. Walls/Ceilings <br /> 6 <br /> 6 ❑ <br /> 23. Cleaning FrequenU 1010mammm <br /> Structure Operation<:J'��ater,yf <br /> �__Df-well Construction <br /> El -1 2. gia <br /> Connection <br /> Structure Operation M /2, f,,2-,O <br /> Lj 0 � <br /> Properly Graded to Sewer <br /> El El [-4. Drain <br /> El El 5. Smooth/Cleanable <br /> El 6. Coving <br /> El El 7. Cleaning Frequency <br /> Structure Operation a IS <br /> El ❑ <br /> - Smooth/Cleanable <br /> X_ <br /> 9. Frequency <br /> Structure Operation eq <br /> 11 El _4-,-_*ff'Condition <br /> El n - <br /> 11. ation <br /> Structure Operatloj, ood 2 <br /> 1:1 ElStorage <br /> 13. Ins <br /> Structure Operation Imal,P!jposal <br /> 11 El -jA_R@wm9rTr`o`m_Premises <br /> El OPA115. Other <br /> Structure operation F-Sewage Disposal <br /> 1:1 El 1 16. Septic System <br /> El Elk1 7. Sewer <br /> r <br /> Structure ahl s Vaccinsiflon- <br /> RECEIVED B INSPECT , <br /> ❑ =01"cale-amsr'smises 77 <br /> VECTOR CONTROL TNSPECTION FORM <br /> EHD 40-06 4/6/12 Page of <br />