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�O,.�R'u�N••.CO VAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, <br /> Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VECTOR OR CONT INSPECTION 1-ORM <br /> lffillfiffM DBA INSP:C ON ATE <br /> Structure Operation /S <br /> ❑ ❑ 1. well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection a V 41 , <br /> Structure Operation Manure Managemeryl OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ng "-✓ <br /> ❑ ❑ 4. Concrete Tanks) (NSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning -tze <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DIspO I _ <br /> ❑ ❑ 7. Bu in ith 2-of Cover <br /> ❑ ❑ 8. ApproAd Concrete Tank <br /> ❑ ❑ 9. Re Val from Premises <br /> Structure Operation vectflfr Control <br /> ❑ ❑ 10. omestic FI <br /> ly Fannia FI <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 113. Pupae <br /> ❑ ❑ 14. Adult <br /> 11 El 15. Light Po ulation <br /> 1:1 Ey 16. Moderate Population <br /> El17. Heavy Population <br /> Structure eration /W <br /> Feedingater <br /> 1:1 ❑ 18. Water Trou hs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Structilre Operation Houses <br /> ❑ 21. Floors <br /> ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin2 Fre uenc <br /> e` - <br /> Structure Operatic Wat <br /> ❑ ❑ 1. Well Construction <br /> 1:1 112. Cross Connection -� <br /> Structure Operatio F or <br /> ro erl Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable re� <br /> 6. Covin <br /> El 7 anin Frequency <br /> Structure Operation <br /> ❑ ❑ B. Smooth/Cleanable <br /> ❑ ❑ . Cleaning Frequency <br /> Structure Operation Ca <br /> ❑ ❑ F12. <br /> dition <br /> tation <br /> Structure Operation <br /> ❑ ❑ a e <br /> ct/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. <br /> Structure Oper n Sewag@ DiS <br /> ❑ ❑ Se tic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation abies Vaccinat' RE INSPECTOR <br /> ❑ ❑ ertificate on Premises Y <br /> VECTOR CONTROL NSPECTION FORM <br /> EHD 40-06 4/6/12 Page Of <br />