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oggl?!!Y• o SAN JOAQUIN COUNTY <br /> y< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • :.,< N;� • Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> trFOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DATE <br /> Structure Operation i <br /> ❑ ❑ 1. Well Constructio PREMISE ADDRESS RE-INSPECTI N DATE <br /> ❑ 2. Cross-Conn on ® N, <br /> StTEte operation Manure Manafiement OWNER/OPERATOR PHONEeZo-Fj- <br /> El ❑ 3. Spreading nd Disking 4-Q` <br /> ❑ ❑ 4. Concrete,4anks NS ON TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagoo ng S <br /> ❑ 6. Com sting The items below represent code violations and musi be corrected: <br /> Structure Ope tion Bird 4isposal <br /> ❑ ❑ 7. Ifurying with 2"of Cover <br /> ❑ ❑ 8/Approved Concrete Tank <br /> ❑ ❑ V4. Removal from Premises C <br /> Structure Operation ector Control <br /> ❑ ❑ 1k Domestic FI <br /> El 11. annia FI <br /> ❑ 12. Nrvae <br /> ❑ 13. 09ae <br /> ❑ 14. Adu <br /> ❑ ❑ 15. Light kopulation <br /> El 1116. Modena Population <br /> 11 El17. Heavy Po ulation <br /> structur Operation FeedinglWat r <br /> El 18. Water Trou94 <br /> kEl19. Cu s or Bowls + <br /> 20. Food Storage <br /> ructure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings 3. n <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> B <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors ;% <br />