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,otQui" .� SAN JOAQUIN COUNTY <br /> 2 .err <br /> W :� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> •�q.. :,N;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> /FOR <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA10C44, INSPEC ION AT�E <br /> Structure Operation ?//!?/// <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection—_/_ V - <br /> Structure Operation Manure Mana eme OW/NER/OPERATOR /PHONE <br /> 130 3. Spreading and Dis mg L. ®7 <br /> ❑ ❑ 4. Concrete Tanks INS ECTION TYPE PROGRAM ELEMENT 2-CORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo I <br /> ❑ ❑ 1 7. BurvingAth 2"of Cover ® P' <br /> ❑ ❑ 8. Appr ed Concrete Tank <br /> r <br /> ❑ ❑ 9. Re oval from Premises " <br /> Structure Operation Vec r Control <br /> ❑ ❑ 10 Domestic FI <br /> 1 f. Fannia FI r <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 113. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Li ht Population r <br /> ❑ Q1 16. Moderate Population <br /> ❑ 17. Heavy Population <br /> Structure oj4eration Feeding/Water <br /> ❑ ❑ 18. Water Troughs — ) ^ <br /> 0El19. Cups or Bowls <br /> 20. Food Storage <br /> Structu0 Operation Houses <br /> ❑ 1 21. Floors T r� <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleaning Frequency <br /> Structure Operation ater <br /> ❑ ❑ 1. Well Construction <br /> 2. s Connection ��"' <br /> Structure Operation loot <br /> s <br /> 110-11 6. Property Graded to Sewer <br /> ❑ ❑ Drain <br /> ❑ ❑ 5. Smooth/Cleanable .� <br /> El D 6. Covin <br /> Y. ning Frequency <br /> Structure Operation QW <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ ning Frequency <br /> Structure Operation ca <br /> ❑ ❑ . Condition <br /> nitation <br /> Structure Operation O <br /> -212 <br /> ❑ ❑ 2. Stora e <br /> 13. insect/vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> StructurA0peration ispos <br /> ❑ stem❑StructurcCin RECz!L <br /> ❑ te on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page of 4 <br />