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PqutN <br /> ,a...,........�o SAN JOAQUIN COUNTY <br /> Ur 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 OR �® �a p� <br /> VECTOR CONT SPECTI®N FORM <br /> DBAINS¢P�Et7TIO DATE <br /> Structure Operation /�/"� /el <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS V RE-INSPECTION DATE <br /> 13 El2. Cross-Connection 9y7„S-/ <br /> Structure Operation Manure Mana eme 4 OWNEOPERATOR ! <br /> 11 El 3. Spreading and Di ing < l 2 0 f/fS/-6 PC7 <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning _,5- 0 f 00a 6 7 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos I 10 1 <br /> n, <br /> ❑ ❑ 7. Burying th 2"of Cover r <br /> ❑ ❑ 8. A rov d Concrete Tank IF <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation vect9i Control <br /> ❑ ❑ 10. omestic FI <br /> 1 1Z Fannia FI f� <br /> ❑ ❑ A. Larvae '� <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population -- <br /> ❑ 16. Moderate Population ' rr <br /> ❑ In 17. Heavy Population <br /> Structure 00-ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs - ,h <br /> 1:1 El 19. Cups or Bowls Valerl <br /> 20. Food Storage <br /> Structu54 Operation Houses <br /> ❑ 21. Floors <br /> El22. Walls/Ceilings J. <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation at@r <br /> ❑ M" We <br /> onstruction <br /> El Connection <br /> StructureOGraded to Sewer <br /> ❑ ❑ 4. Drain 'D( /-.7 <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. 2Lqging Frequency <br /> Structure Operation all 1 a f <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation ag <br /> ❑ ❑ Condition <br /> El El nation <br /> Structure Operation F <br /> ❑ ❑ 12. Stora e <br /> 13. Insect/Vermi <br /> Structure Operation a j <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ j0t15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ Se tic S stem <br /> ❑ ❑ 17. Sewer <br /> Structure Operation abies Vaccination REC INSP TO <br /> ❑ ❑ 8. e i icate on Premises ?' <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />