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�oR"•co 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 />�rFORt� <br />VECTOR CONTROL INSPECTION FORM <br />DBA INS P TI/N A E <br />Structure Operation Water Mfell <br />El❑ 1. Well Construction PREMISE ADDRESS ®® RE -INSPECTION DATE <br />❑ ❑ 2. Cross -Connection /+� , oellL- <br />Structure Operation Manure Mana em t OWNERIOPERATOR P�IONE t ®�, <br />El 11' 3. Spreading and king , ( T <br />cis <br />❑ ❑ 4. Concrete Tan INSPECTION TYPEPROGRAM ELEMENT RECORD ID <br />❑ E]5. Lagooning J <br />❑ ❑ 6. Composti g The items below represent code violations and must be corrected: <br />Structure Operation Bird Dis osal <br />❑ ❑ 7. Bu with 2° of Cover <br />❑ ❑ 8. A roved Concrete Tank 41 <br />❑ ❑9. emoval from Premises <br />Structure Operation ctor Control <br />❑ ❑ 10. Domestic FI <br />11. Fannia Fly 13 aeo <br />1:1❑ 12. Larvae / <br />❑ EY 13. Pupae <br />❑ 14. Adult <br />❑ ❑ 15. Light Population r r <br />❑ ❑ 16. Moderate Population <br />❑ ❑ 17. Heavy Population <br />Structu Operation FeedinglWater <br />❑ ❑ 18. Water Troughs �+ <br />❑ 19. Cups or Bowls / <br />20. Food Storage <br />ructure Operation Houses <br />❑ ❑ 21. Floors i <br />❑ ❑ 22. Walis/Ceilin s <br />❑ ❑ 23. cleaning Frequency <br />Structure <Operatiqn Water I <br />❑ ❑ 1. Well Construction �° ® C P <br />El Ej ss Connection <br />Structure operatio <br />Properly Graded to Sewer <br />❑ ❑ Drain r0 f <br />1:1 El 5. Smooth/Cleanable <br />6. Covin <br />11 El 7. CleaningFre uen <br />Structure Operation Walls <br />❑ ❑ 8. Smooth/Cleanable <br />❑ ❑ Frequency <br />Structure Operati C ge <br />❑ ❑ 0. Condition <br />ation <br />Structure Operatio <br />❑ ❑ 2. Storage <br />Insect/Vermin <br />Structure operation Animal Disposal <br />❑ ❑ 14. Removal from Premises <br />❑ ❑ Other <br />Structure Operat' SeW <br />❑ ❑ 16. Septic System <br />❑ ❑ 17. Sewer <br />Structure OpeTj n les Vaccinati RECEIVED Y` INSPECT R <br />1:1 ❑ icate on Premises <br />VECTOR CONTROL INSPECTION FORM / <br />EHD 40-06 4/6/12 Page r of J, <br />