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oAQut" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> �gGrFOR��P Telephone:(209) 46®8-3420 Fax.(2®09) 464--01/ C <br /> 3'8 Web:wwwsjgov.org/ehd <br /> VECTOR CONTROL <br /> L Sr ECTION FORM <br /> DBA INSPECTION DATE <br /> Structure O ration e . {C �� -71.2 <br /> ❑ ❑ 1. Well Construction PREMISE <br /> tBAtDDDRE S RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection /® l 3 07 <br /> Structure Operation Manure Mana eme OWNER/OPERATOR PtPNE <br /> ❑ ❑ 3. Spreading and Dis ng 9 3 9® ?(-� <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning / yw r� "b& .2 <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos I <br /> ❑ ❑ 7. Bu in th 2"of Cover <br /> ❑ ❑ 8. A rov d Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises <br /> Structure Operation Vect9f Control <br /> ❑ ❑ 10. omestic FI <br /> 111 Fannia FI <br /> ❑ ❑ A. Larvae a <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population A <br /> ❑ 16. Moderate Population .4- <br /> ❑ 17. Heavy Population <br /> Structure O ration Feeding/Water <br /> El ❑ 18. Water Trou hs <br /> 1:1 ❑ 19. Cups or Bowls <br /> Ej 1-1 20. Food Storage p- <br /> Structu Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Fre uenc r- r <br /> v <br /> Structure Operation ater <br /> ❑ ❑ ell. Well Construction <br /> El El ss Connection <br /> Structure Operation FidoEP <br /> 2. Property Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable re rcy ,off, <br /> El El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation wallS <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 1 9. Cleaning Fre uenc <br /> Structure Operati s <br /> ❑ ❑ 10. Condition <br /> El El nitation <br /> Structure Operation/ Foo <br /> 1:1 El dl 12. Storage <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation Sewa Sal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ <br /> StructureOperation Rabies Vaccinagil RE EIV Y SPECTOR <br /> ❑ ❑ 18. Certificate on Premises o <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page f of <br />