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SAN JOAQUIN COUNTY <br /> 2 � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> <<FO¢ <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA �WAz INSPECTI N DATE - <br /> Structure Operation '' 2--2-71 <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> Structure Operation Manure Mana eme OWNS OPERATOR /PHONE <br /> ❑ ❑ 3. Spreading and Dis ng [ f)3S�- f <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning ,$` )OR- 0,j"p <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo l <br /> ❑ ❑ 7. BurvinqXith 2'of Cover / f` <br /> ❑ ❑ 8. ApprVed Concrete Tank o <br /> ❑ ❑ 9. Re oval from Premises <br /> Structure Operation Veefor Control <br /> ❑ ❑ 1 Z Domestic FI <br /> 1:1 El A. Fannia FI <br /> E] 1:112. Larvae y eapf <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> E] 11 <br /> 15. Li ht Population <br /> E] 16. Moderate Population r h <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Stora e y <br /> Stru ure Operation Houses <br /> ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequeng <br /> Structure Operation rWater WAV W <br /> ❑ ❑ ell Construction <br /> 2. Cross Connection <br /> h n�, <br /> Structure Operationr IO rS <br /> El El ro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> ❑ 6. Covin <br /> 1:1 El 7. leanina Frequency �i <br /> Structure Operation W S <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. anin Fre uenc <br /> Structure Operation Ca es <br /> ❑ ❑ Condition <br /> 1 anitation <br /> Structure Operation F Od <br /> ❑ ❑ Stora e <br /> 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ 131W 6 Septic System <br /> ❑ 17. Sew <br /> StructureOperation abies Vaccinatior� R D BY INSPECTOR <br /> ❑ ❑ eon remises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />