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Ra"`" SAN JOAQUIN COUNTY <br /> a � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, <br /> Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOR ® ® ® /'a �® <br /> VECTOR CONTROL INSPECTION FORM <br /> EMEMEHISM DBA INSPD <br /> Structure Operation � �® f <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS ] RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection /// <br /> Structure Operation Manure Mana em t OWN OPERATOR /P)IONE ) <br /> 13 E] 3. Spreading and Di ing l ! 33�1- a116 <br /> ❑ ❑ 4. Concrete Tank INSPECTION PE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagoon-ng a OOOP D y <br /> ❑ ❑ 6. Compostinv The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disp al <br /> ❑ ❑ 7. Burvin,4ith 2"of Cover <br /> ❑ ❑ 8. ApPrAd Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Ve or Control <br /> ❑ ❑ 1 . Domestic FI <br /> rl 1. Fannia FI <br /> ❑ 1112. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. HeavyPopulation �- ,L, / <br /> Structure peration FeedingMater <br /> 1:1 ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 1:1 El 20. Food Storage ,- <br /> Struc re Operation Houses a,, <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uen <br /> StructurEl e OperatioTCross <br /> �- p <br /> ❑ ❑ nstruction s`X-7 J <br /> onnectionStructure Operation Graded to Sewer <br /> ® ,yyAL--r- <br /> 1:1 <br /> 'r- <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El 7. ing Frequency <br /> Structure Operation W -f "-2-7 <br /> ❑ ❑ ff%yY8. Smooth/Cleanable <br /> ❑ ❑ 9. ng Frequency <br /> Structure Operation a <br /> ❑ ❑ 10. Condition <br /> Sanitation <br /> Structure Operation Fogp <br /> ❑ ❑ ^ Zi E storage <br /> 3.jn§a=ermin <br /> Structure Operation ignimal QjfipOSaV- <br /> 11 ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ . Septic System <br /> ❑ ❑ 7. Se <br /> Structure Oper io Rabies vaccinati VED IN CT R <br /> El18. Certificate on Premis <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />