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OQ`a'utN c � <br /> ,:. ..o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <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 /> �rFOR� <br /> VECTOR <br /> CONTROL <br /> N ® S®cC IN FORM <br /> DBA INSPECTION ATE <br /> Structure Operation 2 p <br /> ❑ ❑T 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection / /�= . <br /> Structure Operation Manure Manage OWN OPERATOR P/tt NE 11 f� <br /> ❑ ❑ 3. Spreading and Di ing ( �l 7 <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE IF PROGRAM ELEMENT RECORDID <br /> ❑ ❑ 5. Lagooning 41'"Sy /0 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispO I r� <br /> ❑ ❑ 7. Bu inWith 2"of Cover a <br /> ❑ ❑ 8. A ro ed Concrete Tank op <br /> ❑ ❑ 9. Rer#6val from Premises ' <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> El El 1 f. Fannia FI <br /> ❑ ❑ 2 Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population r <br /> ❑ 17. Heavy Population <br /> Structureenation Feeding/Water <br /> El 1118. Water Trou hs <br /> ❑ ❑ 19. Cu s or Bowls <br /> I20. Food Stora2e <br /> Structu Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings eo <br /> ❑ 23. cleaning Fre uenc <br /> MOMMEEMESEEMI <br /> Structure Operation Water WOW <br /> ❑ ❑ 1. Well Construction , J <br /> El 171 2. Cross Connection <br /> Structure Operation FI r <br /> El El _ 3. Properly Graded to Sewer <br /> ❑ ❑ k9 4. Drain r <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> _7-CiQaning Frequency <br /> Structure Operati W <br /> ❑ ❑ 8. Smooth/Cleanable <br /> A a <br /> ❑ ❑ 9. 2Wing Frequencv <br /> Structure Operation a <br /> ❑ ❑ Condition <br /> El 1 nitation <br /> M <br /> Operation O d <br /> fora e <br /> 13. insect/Vermin <br /> Operation Animal Dis osal <br /> ❑ Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Wage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure opereti abiea Vaccinatlo RECEIV JCIN R <br /> ❑ ❑ 1 ertificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page_hof <br />