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SAN JOAOUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Y. <br />Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br />iio <br />VECTOR CONTROL INSPECTION FORM <br />VECTOR CONTROL INSPECTiON FORM <br />EHD 40-06 4/6/12 z Page I Of <br />211mimmimm <br />DBA <br />X�6,-Oe <br />INSPECTION DAYE <br />Structure <br />Operation <br />Water Well .1 <br />_D_ �e_ <br />Kle <br />El <br />El <br />1. Well Construction <br />PREMISE ADDRESS <br />RE -INSPECTION DATE <br />El <br />El <br />2. Cross -Connection / <br />-;2/ d' 1-7 /F . /o -I-er <br />Structure <br />Operation <br />Manure Manageme <br />OWNER/OPERATOR <br />- 99 -�, <br />PHONE <br />zo,5?J 41or <br />3. Spreading and Disying/ <br />-).q " w / <br />1 <br />J-_ 3 j" ox - <br />11 <br />E] <br />4. Concrete Tanks/ <br />INS?FCTION TYPE <br />PROGRAM ELEMENT <br />RECORD ID <br />1:1 <br />[:1 <br />5. Lagooning / <br />40"16 _.�e_ <br />4W6 -W <br />A4 0 V400a d y <br />El <br />13 <br />6. Composting/ <br />The items below represent code violations and must be corrected: <br />Structure <br />Operation <br />Bird Dispopfil <br />El <br />El <br />1 7. Bu in jith 2' of Cover <br />❑ <br />n <br />1 8. Approy6d Concrete Tank <br />V <br />1:1 <br />El <br />9. Re56al from Premises <br />Structure <br />Operation <br />Vec!)fr Control <br />1:1 <br />El <br />10. omestic FIV <br />El <br />El <br />El <br />El <br />-1.Y. Fannia FIv <br />X2. Larvae <br />0--it- <br />El <br />El AV <br />13. Pupae <br />El <br />0 / <br />1 14. Adult <br />El <br />0/ <br />15. Light Population <br />El <br />16. Moderate Population <br />A_Ae� ar-e e -,e e-.,,,,. <br />El <br />17. Heavy Population <br />Structure <br />per tion <br />FeedingMater <br />11 <br />El <br />18. Water Troughs <br />11 <br />El <br />19. Cups or Bowls <br />e oe e -o <br />El <br />L] <br />20. Food Storage <br />Struct a <br />Operation <br />Houses <br />El <br />21. Floors <br />El <br />22. Walls/Ceilings <br />A <br />tn <br />EI <br />23. "Cleaning Frequen <br />Structure <br />Operation <br />ate <br />11 <br />Q <br />1. Well Construction <br />El <br />M <br />2. Cross Connection <br />cc 6 <br />Structure <br />Operation <br />COO <br />El <br />"T -Pro perIV Graded to Sewer <br />El <br />❑ <br />4. Drain <br />jee. <br />5. Smooth/Cleanable <br />4-4 <br />6. Coving <br />El <br />Structure <br />Operation <br />7. Cleanino Freauency <br />I -e-"-4 <br />El <br />El g)L <br />8. Smooth/Cleanable <br />11 <br />El wl- <br />- 9. C I eaning Frequency <br />Structure <br />Operation <br />a <br />Condition <br />Ll..,anitation <br />Structure <br />Operation <br />F-60CV <br />11 <br />El <br />Storage <br />El <br />13. Insect/Vermin <br />Structure <br />Operation <br />Animal Disposal <br />11 <br />El <br />14. Removal from Premises <br />El <br />El <br />-15-OwAr-- <br />Structure <br />opera <br />Sewae DiAggSwil) <br />11 <br />Elf) k k <br />. Septic System <br />Li <br />El <br />jz=§Lw�� <br />Structure2!;U <br />1:1 <br />- <br />RablesVaccin _��N <br />;===_ palip <br />RECEI) <br />INSPECTOR <br />0 <br />18. Certificate on Premises 1 <br />VECTOR CONTROL INSPECTiON FORM <br />EHD 40-06 4/6/12 z Page I Of <br />