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SAN JOAQUIN COUNTY <br /> z :ter, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •., u ;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> 4�%}pFtN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION ATE <br /> Structure Operation '6- l V1S- <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INISPECTIONDATE <br /> ❑ ❑ 2. Cross-Connection 35--791 cry. <br /> Structure Operation Manure Managernept OWNERIOPERATOR PHONE <br /> ❑ 1 ❑ 3. Spreading and Dis mg V -2 V 7-? <br /> ❑ ❑ 4. Concrete Tanks/_ INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> El ❑ 5. Lagooning 4V5-�e/ P'80 votloxz) <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos I <br /> ❑ ❑ 7. Bu in h 2-of Cover /^ <br /> ❑ ❑ 8. A rov Concrete Tank <br /> ❑ ❑ 9. Remo al from Premises <br /> Structure Operation vect0 Control <br /> ❑ ❑ 10. mestic FI <br /> 11.Aannia FI s® <br /> ❑ ❑ 1 Z Larvae Vim✓ <br /> ❑ ❑ 3. Pupae <br /> 1:1 El14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ EY 17. Heavy Population <br /> Structure 01396tion Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> El El 19. Cups or Bowls ® <br /> 0 El 20. Food Storacie <br /> Structure/ Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ 1 22. Walls/Ceilings <br /> ❑ 23. Cleaning Fregen <br /> Structure Operation ater <br /> ❑ ❑ 1. Well Construction .00.- <br /> Cross Connection <br /> Structure Operation aem <br /> El erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El 7-.CleaningZ-.Cleaning Frequency <br /> Structure Operation aIIS <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ . Cleaning Fre uency 0 <br /> Structure Operation Cages <br /> ❑ 1 ❑ 10. Condition <br /> 1. Sanitation <br /> Structure Operation Fob <br /> ❑ ❑ tora e <br /> El 1:1 3. Insect/Vermin <br /> structure operation inial Disposal <br /> ❑ ❑ L&Removal from Premises <br /> ❑ ❑ <br /> Structure Operation Sewage DispO l <br /> ❑ ❑ a Se tic S stem <br /> ❑ ❑ 17. Sewer <br /> Structure Operation - abieS Va C IVSD BY INSPECTOR <br /> 1:1 E] 8. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 t^ A Page of-J <br />