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aU"`" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ur ?x <br /> Y. <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • ... ;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> "9<<F ORS <br /> VECTOR CONTROL <br /> N ® L ryG` ION FORM <br /> DBAINSPECTION D TE <br /> Structure Operation ///1 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection -/// <br /> Structure Operation Manure Managemepifit OW14PVOPERATOR P NE � <br /> El E] 3. Spreading and Dis Ing V" ®.? <br /> ❑ ❑ 4. Concrete Tanks INSPECTioh TYPEPROGRAM ELEMENT REECORD ID <br /> ❑ ❑ 5. Lagooning `S /' <br /> ❑ ❑ 6. composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispogifil en <br /> ❑ ❑ 7. Bu in ith 2"of over ° <br /> ❑ ❑ 8. Approv4d Concrete Tank <br /> ❑ ❑ 9. Re val from Premises <br /> Structure Operation Vect r Control <br /> ❑ ❑ 10. omestic FI <br /> 1 Fannia FI / <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ J 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure O ration FeedingMater <br /> 1:1 ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structu operation Houses <br /> ry ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fr uenc <br /> Structure ElOperation <br /> ❑ ❑ 1. Well Construction <br /> onnection <br /> Structure Operation FI00 <br /> El <br /> roe Graded to Sewer <br /> ❑ ❑ W4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable h ^� <br /> 1:1 El 6. Covin <br /> El El 7.-Lkaning Frequency <br /> Structure Operatic, S <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ Frequency <br /> Structure Operat' n ca <br /> ❑ ❑ 0. Condition <br /> 11. Sanitation <br /> Structure Operation -Food <br /> ❑ ❑ 12. Storage <br /> 13 <br /> Structure Operatic, Animal Dis <br /> ❑ ❑ j . Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation ge Dispo <br /> ❑ ❑ e tic System <br /> ❑ ❑ X17. <br /> Structure Operation bie ination ECEI INSPE T R <br /> ❑ ❑ 8. Certificate on Premises ✓'" <br /> VECTOR CONTROL I TION FORM <br /> EHD 40-06 4/6/12 Page of <br />