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,o"a"'"''•Co SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0. X <br /> ; <br /> F. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • .. ;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> gCiFp6�iN ® mss CONTROL <br /> ®p� <br /> VECTOR CONTR INSPECTION FORM <br /> DBA <br /> INSPECTION DAT t� <br /> Structure Operation �� 3 f / <br /> ❑ ❑ 1. Well ConstructionPREMIIISE ADDRESS RE-INSPECTION DATE <br /> E] El2. Cross-Connection /7 <br /> Structure Operation Manure Mana em t OWN OPERATOR P ONE <br /> ❑ ❑ 3. Spreading and Di Ing C 42, -3/ <br /> ❑ ❑ 4. Concrete TanksINSPECTION TYPE PROGRAM ELEMENT ORD ID <br /> ❑ ❑ 5. Lagooning a�Zg 2 V4, <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo al 117 <br /> ❑ ❑ 7. BurvinoAith 2"of Cover <br /> ❑ ❑ 8. A r ed Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10. Domestic FI <br /> 1 f. Fannia FI <br /> ❑ ❑ 2. Larvae �- <br /> ❑ ❑ 113. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> ❑ EY 16. Moderate Population <br /> ❑ 17. eavy Population <br /> Structure O ration Feeding/Water <br /> 11 El 18 Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> El I El 20. Food Stora e r e <br /> ZED <br /> Operation Houses <br /> El 21. Floors <br /> El 22. Walls/Ceilings <br /> ❑ 23. Cleanin Fre uenc �- <br /> r ® P <br /> Structure Operation Water <br /> ❑ ❑ 1. Well Construction <br /> El 2. ss Connection <br /> Structure Operatio FI <br /> El ❑ . Properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El El 6. Covin _ <br /> 7. Cleaning Fre uenc <br /> Structure Operatio aI1S <br /> ❑ ❑ 08. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operationages <br /> ❑ ❑ 0. Condition 0 <br /> L_§Eitation <br /> Structure Operation F <br /> ❑ ❑ <br /> Storage <br /> El El 1 Ins <br /> Structure Operation Animal Dis <br /> ❑ ❑ 4. Removal from Premises <br /> ❑ ❑ Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation es Ion RECEIVED BY INSPECTOR <br /> ❑ . Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />