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�Q�Qu'N .co SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> { <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> • Coq., ::,NSP• Telephone:(209)468-3420 Fax:(209)464-0138 Web:wWW.sjgov.org/ehd <br /> �lFOCR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECT NN DATE <br /> Structure Operation "� 2113 <br /> ❑ ❑ 7-7 <br /> PREMISE ADDRESS / RE-INSPECTION DATE <br /> ❑ ❑ a2 Y`�l.S 0 �e�.' mss, �[ .m <br /> Structure Operation e OWNER/OPERATOR PHONE <br /> ❑ ❑ . preangas g � q),3 e§s^ <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning �v.6 /P o 5--�( <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DispoS <br /> 1:1 El7. Bu in h 2"of Cover <br /> ❑ ❑ 8. Approvq6 Concrete Tank / <br /> ❑ ❑ 9. Rem al from Premises ' <br /> Structure Operation vect0 Control <br /> ❑ ❑ 10. mestic FI <br /> 11. annia FI <br /> ❑ ❑ 1V Larvae <br /> ❑ ❑ A. Pupae <br /> ❑ ❑ 114. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ Ey 17. Heavy Population <br /> Structure o atlon Feeding/water <br /> ❑ ❑ 18. Water Troughs r <br /> 11 ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structur Operation Houses <br /> ❑ ❑ 21. Floors ®� <br /> ❑ 22. Walls/Ceilings <br /> ❑ 1 23.Cleaning Fre uenc <br /> Structure Operation mater et47"v <br /> ❑ ❑ . Well Construction <br /> 2. Cross Connection �+ <br /> Structure Operation o d <br /> El 3. Properly Graded to Sewer <br /> ❑ ❑ . Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> El 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation wa <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation es <br /> ❑ ❑ 0. Condition <br /> 1 1.jSanitation <br /> Structure Operation oo <br /> ❑ ❑ 2. Storage <br /> 13. Ins <br /> Structure Operation ai Dis O <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation ewage Disposal <br /> ❑ ❑ 3f2Septic System <br /> ❑ ❑ 17. <br /> Structure Operation abies Vaccin RE Y INSPECTOR <br /> ❑ ❑ 18. Certificate on Premises r <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page_of <br />