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BoRout" SAN JOAQUIN COUNTY <br /> a. ....... <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • •.. M ;P. Telephone:(209)468-3420 Fax:(209)464-0138 Web:Wwwsjgov.org/ehd <br /> q<rpt�t� <br /> VECTOR CONTROL R SPECTION FORM <br /> DBAINSPECT ON DATE <br /> Structure Operation -7 /'7 1 Y <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection J—L "?jg41 <br /> Structure Operation Manure Mana ems OWNS OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ng 9)36 ^ <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispos i <br /> ❑ ❑ 1 7. Burying th 2°of Cover °.- <br /> ❑ ❑ 1 8. ApproVdd Concrete Tank <br /> 11 El 9. Re val from Premises ® e <br /> Structure Operation vect r Control <br /> ❑ ❑ 10. omestic FI <br /> 1 X. Fannia Fly / <br /> ❑ ❑ 2. Larvae O <br /> ❑ y 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> El Ey 16. Moderate Population <br /> �' <br /> ❑ 17. Heavy Population <br /> Structureeration Feeding/Water <br /> El ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls r <br /> 20. Food Storage <br /> Structu,A Operation Houses <br /> ❑ 21. Floors ®, <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. cleaning Frequency <br /> Structure Operation j ater <br /> ❑ ❑ Well Construction <br /> Cross Connection <br /> Structure Operation <br /> El El .J�—Properly Graded to Sewer <br /> ❑ ❑ . Drain 74 <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7.Sleaning Frequency <br /> Structure Operation <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ . Cleaning Frequency + tom® <br /> Structure Operation a e <br /> ❑ ❑ 0. Condition <br /> E] El f2l Sanitation <br /> Structure Operation <br /> ❑ ❑ Stora e <br /> 3. Insect/Vermin <br /> Structure Operation I imal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Operation swage Disposaf <br /> ❑ ❑ is S stem <br /> Structure Operatio abieS Vaccination RE D BY INSPECTOR <br /> ❑ ❑ . e i ica a on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page I of <br />