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SAN JOAQUIN COUNTY <br /> N:._ < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> • q..: ;�• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFORN <br /> PT:4-- VECTOR CONTROL INSPECTION FORM <br /> DBA ' Dc+ <br /> INSPECTION DAX <br /> Structure Operation Water Well t L1CC <br /> ❑ ❑ 1. Well Constru on PREMISE ADDRESS ' RE-INSPECTION DATE <br /> El 1-] 2. Cross-Conn ction ;Xn3 8Lt8 Al ��'r(r' IDU <br /> Structure Operation Manure Ma a ement ow OPERA OR )) )J f^ PHONE <br /> ❑ ❑ 3. Spreadin and Disking (�h,t a i.1/��. fLI!� ►� - p/�'+ <br /> ❑ j0peration <br /> 4. Concret anks INSPECTION TYPE ��I t_ PROGRAM ELEMENT RE RD ID <br /> ❑ 5. Lagoon' g ��f(. .' '/`/1�1E -L� <br /> ❑ 6. Comp ting The items below represent code violations and must be corrected: <br /> Structure Bird Di posal <br /> ❑ 7. Bu with 2"of Cover <br /> ❑ ❑ 8. A oved Concrete Tank I <br /> ❑ ❑ 9. Re oval from Premises In, Cw t-J rp K weU <br /> Structure Operation Vecthr Control <br /> ❑ ❑ 10.homestic FI <br /> 11.1 Fannia FI .i <br /> ❑ ❑ 1j Larvae QC1A C Vl (.��I CL1--. <br /> ❑ ❑ Pupae <br /> ❑ ❑ 4. Adult <br /> ❑ ❑ 15. Light Population r- <br /> / <br /> El 1:116. Moderate Population J r ,cd C`,i}�rest / I y A'6'zj-e- <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operati n Feeding/Water <br /> ❑ EY 1 18. Water Troughs <br /> El 19 Cups or Bowls 'sem/�l <br /> ❑ 20. Food Storage <br /> Structureeration Houses <br /> 1:1 E] <br /> 21. Floors <br /> 1:1 ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uency A16 <br /> V'& /cuff o-h c r� <br /> Structure operation Water ell <br /> ❑ ❑ 1 ell nstruction <br /> 2. Cross Connection <br /> Structure Operation OOrp" <br /> ❑ ❑ 3. Proper) Graded to Sewer <br /> ❑ ❑ <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ ❑ 6. Covin <br /> ❑ ❑ 7. Cipailing Frequency <br /> Structure Operation ally <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation ages <br /> ❑ ❑ 10. Condition <br /> ❑ 11. Sanitation <br /> Structure Operation OOd <br /> ❑ f2-storage <br /> ❑ 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ <br /> ❑ ' 17. Se tic stem �" 1��0 /�Q��^-�Y&❑ r 11 <br /> Structure per8tion aCCinatlOn RECIVED BY C INSPE OR <br /> El1118. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page A of <br />