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pp- <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> /POR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation E 71111/-3 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection l,7 "S- <br /> Structure Operation Manure Managernerit OWNER/OPERATORHONE <br /> El E] 3. Spreading and Dis g �,- / ® y <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning o a 4K.- o W r <br /> El ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos <br /> ❑ ❑ 7. Bu in h 2°of Cover �1 ✓i <br /> ❑ ❑ 1 8. Approv06 Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation vect0 Control <br /> ❑ ❑ 10. omestic FI <br /> El 0 11. annia FI <br /> ❑ ❑ 1/ Larvae ` <br /> ❑ ❑ 3. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population J� h <br /> ❑ 17. Heavy Population <br /> Structure Opgration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 11 ; [:] 20. Food Storage <br /> Struct a Operation (-louses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation Water W <br /> ❑ ❑ . Well Construction <br /> 2. Cross Connection <br /> Structure Operation oo ` <br /> operly Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 11 El _7_.c1Qaninq Frequency <br /> Structure Operatio WaIIS ° f <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. •n,g Frequency <br /> StructurefS <br /> ages <br /> ❑ . Condition <br /> El EE11 -4 itation <br /> Structureo �0 f <br /> ❑ . Storage <br /> E] E01 3. Insec <br /> Structurenimal Dis O <br /> ❑ Removal from Premises <br /> ❑ . Oth <br /> Structureewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. <br /> StructureOperation abies va lon IVED BY INSPECTOR <br /> F-1 ❑ Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />