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ORQu'N O <br /> ,... 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 /> <<F ORS ® ®p� <br /> VECTOR CONT SECTION FORM <br /> DBA INSPECTIO DATE <br /> Structure Operation r ,® / <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Managernelift OWNERIOPERATOR VPHONE <br /> ❑ ❑ 1 3. Spreading and Dis ing le 3 3 - /316 <br /> ❑ ❑ 4. Concrete Tanks INSPE TION YPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning 4, <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dlspo l <br /> ❑ ❑ 7. BurvinqAith 2"of over ° <br /> ❑ ❑ 8. Appr ed Concrete Tank , <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation VeC r Control <br /> ❑ ❑ 1 VD.m.stic FI <br /> El Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult s <br /> ❑ 15. Li ht Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population 1 <br /> Structure Operation Feeding/Water <br /> 0 <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Stru ure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operatio stet We <br /> ❑ ❑ 1. ell Construction <br /> 2. Cross Connection <br /> Structure Operation <br /> El a1 3. Pro erl Graded to Sewer <br /> 1:1 1:1 ft-4. Drain r <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation W ' <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ Cleaning Frequency <br /> Structure Operation,,- <br /> El <br /> peratio a eS <br /> ❑ ❑ . Condition <br /> El tion A <br /> Structure Operation Fo <br /> ❑ ❑ 12. Storage <br /> El 1:1 <br /> Structure Operation Animal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operatio ewage Dispose <br /> ❑ c ystem <br /> ❑ ❑ 17. Sewe <br /> Structure Operatio a les Vaccin <br /> AW RECEIVED BY INS CT R <br /> ❑ ❑ 18. ertificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />