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SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N... ,.< <br /> `. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> cq •. ::-..•;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<F OFRa <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA j lb <br /> INSPECTIO DATE <br /> Structure Operation L c[£.lLt.d Z..4 L l "e, TI , / <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana em t OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Di ingi /- <br /> ❑ ❑ 4. Concrete Tanks INS aECTIO�TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning I A-e '-Q 4W 5-1/ " O{ O�Pad ' <br /> ❑ ❑ 6. Composting/ The items below represent code violations and must be corrected: <br /> Structure Operation Bird DISp! al <br /> ❑ ❑ 7. Bu in ith 2"of Cover . T'! a'l�rt- +�1 Ltd Qs ra✓ <br /> ❑ ❑ 1 8. Appr ed Concrete Tank �d <br /> ❑ ❑ 9. Re oval from Premises "- *� � � 10-1- <br /> Structure Operation vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> El El 3e. Fannia FI <br /> ❑ ❑ �f77 <br /> 12. Larvae '- <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population - `�_`"" '`� Ll.�'e �L-etst �i c!✓ .1t Gf0 /T�u-r <br /> El �' <br /> 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure peration Feeding/Water <br /> ❑ ❑ 1 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls �¢ <br /> 20. Food Storage <br /> Struc re Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fregen <br /> Structure Operation 01_ <br /> ❑ ❑ 1. Well Construction <br /> Connection <br /> Structure Operation--Ffoorg- <br /> [:] <br /> 3. Property Graded to Sewer Q <br /> El 4. Drain GL/u F R� <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El 7. Cleaning Frequency <br /> Structure operation WaIIS <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑W 4- 9. Cleaning Frequency <br /> Structure Operation a e <br /> ❑ ❑ 10. Condition <br /> El 11 Ranitation <br /> Structure Operation Food <br /> ❑ ❑ Stora e <br /> 13. sect/vermin <br /> Structure Operation nimal DI al <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ <br /> ❑ ❑ 17. S <br /> Structure opera abies Vaccination_-) REC INSPECTOR c7e /�►�� <br /> ❑ ❑ 18. Certificate on Premises �fr�i r <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />