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F <br /> Ackku <br /> oI-N. <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> q.- ;..•;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:wWw.sjgov.org/ehd <br /> <<F ORN ® ® p� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTI ND T <br /> Structure Operation ®2� <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> 1:1 [12. Cross-connection <br /> Structure Operation Manure Mana eme t OWNER/OPERATOR PHONE <br /> e-1. <br /> ❑ ❑ 3. Spreading and Di ing /2 "/ ( "9/3 -3 tj73 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 44qs-4/ Be a" dad <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispO al <br /> ❑ ❑ 7. Bu 'n ith 2"of Cover ®y el 1 <br /> ❑ ❑ 8. Appro4d Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve or Control <br /> ❑ ❑ 1 . Domestic FI <br /> El t. Fannia FI J y�i <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Aperation Feeding/Water <br /> ❑ ❑ 18. Water Trou hs _ <br /> ❑ ❑ 19. Cups or Bowls 7 <br /> 20. Food Storage <br /> $.Ur� <br /> operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings 60 <br /> ❑ ❑ 23. Cleanin Fre uen <br /> Em ummammim <br /> Structure Operation Water W <br /> ❑ me, 1. Well Construction <br /> El I El 2, Qm§s Connection <br /> Structure Operation FIOo <br /> 3. Pro edy Graded to Sewer <br /> ❑ ❑ 4. Drain S "!v e, <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7 in Fre uenc <br /> Structure Ope2tio Walt"§ <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ 119. Cleaning Frequency <br /> Structure Operatio Cages <br /> ❑ Condition <br /> ation <br /> Structure Operatio FOO <br /> ❑ ❑ n . Stora e <br /> Structure Operat Animal DiS <br /> ❑ ❑ . Removal from Premises <br /> Structure opera' Sewage <br /> ❑ ❑ 1 Se tic System <br /> ❑ ❑ ewer <br /> Structure Operation -ftn I RE 1 D BY IN T R <br /> ❑ ❑ 8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page ? of <br />