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Aa SAN JOAQUIN COUNTY <br /> N {to- <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 /> ��FOR <br /> VECTOR CONTROL INSPECTION FO®M <br /> DBA INSPECTIO DA�T <br /> Structure Operation "7 4!/ <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana erne t OWNER/OPERATOR V P ONE <br /> ❑ ❑ 3. Spreading and Di ingJ <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 4--f j'y 0 S-'d 3 41"e <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 7. Bu in th 2"of Cover <br /> ❑ ❑ <br /> 8. Appo,,Jd Concrete Tank r <br /> 1:1 El9. Rem al from Premises ' ° <br /> Structure Operation vect Control <br /> ❑ ❑ 10. omestic FI <br /> 13 0 11 Fannia Fly 310 <br /> ❑ <br /> El Larvae <br /> ❑ ❑ Z13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. eavy Population <br /> Structure O ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Stora e <br /> Structu Operation Houses ,, <br /> ❑ 21. Floors <br /> ❑ 22. Wall./Ceiling. <br /> ❑ 23. Cleanin Fre uenc <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> El El V 2. Cross Connection <br /> Structure Operation Floors <br /> 3. Properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. CleaningFrequency <br /> Structure Operation Walls <br /> ❑ ❑ Smooth/Cleanable <br /> ❑ ❑ V 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 1 . Condition <br /> El OW 11. sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 4. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ 117. Sewer <br /> Structure Operation Rabies Vaccination IVSD BY IN P CTOR <br /> ❑ ❑ V L118. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />