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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �q.. .. ;P Y. <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> Rc* <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation Water Well I -7Z/7" <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection `®!Lia 12- <br /> Structure Operation Manure Manageme OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ingA 's: (W'9) Y93- 'l <br /> Cl ❑ 4. Concrete Tanks INS= CTION TYPIf PROGRAM ELEMENT RECORD ID _ <br /> ❑ ❑ 5. Lagooning Q) -0 <br /> ❑ ❑ 6. CompostinV The items below represent code violations and must be corrected: <br /> Structure Operation Bird DIspO al <br /> ❑ I ❑ 7. Buryino4ith 2°of Cover ! r� <br /> ❑ ❑ 8. App/ed Concrete Tank <br /> ❑ ❑ 9. R oval from Premises <br /> Structure Operation zannia <br /> or Control <br /> 1:1 Elomestic FI <br /> El Eli FI <br /> ❑ ❑ 12. Larvae /0 etql <br /> ❑ ❑ 13. Pupae 01 <br /> ❑ ❑ 14. Adult <br /> ❑ EX 15. Light Population <br /> ❑ 16. Moderate Population 42.44 <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water Lee ?40 <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Stru re Operation Houses f <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency_ <br /> Structure Operation ater W <br /> ❑ ❑ Well Construction <br /> Cross Connection <br /> Structure Operation <br /> ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 01 4. Drain <br /> ❑ ❑ . Smooth/Cleanable <br /> 6. Covin ® � d® <br /> 7. eaning Frequency <br /> Structure Operation s <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation <br /> ❑ ❑ 10. Condition <br /> 11 nitation <br /> Structure Operation <br /> ❑ ❑ . Storage <br /> n0peration <br /> 3. Insect/Vermin <br /> Structure q <br /> Dis OSavovalfromPremises <br /> ❑ r <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 1 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Opereti a IeS V8C RECEIVED BY INSPECTOR <br /> ❑ 18. Certificate on Premises Z <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />