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uv I... c SAN JOAQUIN COUNTY <br /> 2 '4 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 /> VECTOR OR CONTR L INSPECTION 1-ORM <br /> DBA K ^ INSP��ON DATE <br /> Structure Operation O <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection d d <br /> Structure Operation Manure Mana em t OWN OPERATOR PWONE <br /> ❑ ❑ 3. Spreading and?/king / ( Q <br /> ❑ ❑ 4. Concrete Tan INSPE TION TYPE PROGRAM ELEMENT RECORDID f® t� <br /> 1:1 [15. Lagooning '� efy� �7 �d <br /> ❑ ❑ 6. Composti96 The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dis Osal n� <br /> ❑ ❑ 7. Bu i with 2"of Cover <br /> ❑ ❑ 8. Ap oved Concrete Tank <br /> ❑ ❑ 9. F34moval from Premises ° <br /> Structure Operation V kfor Control <br /> ❑ ❑ A. Domestic FI <br /> 11. Fannia FI <br /> ❑ ❑ 12. Larvae <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ 14. Adult <br /> ❑ 15. Light Population <br /> ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedinglWater <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> 20. Food Storage <br /> Stru re Operation Houses <br /> ❑ 21. Floors , <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 1 23. Cleaning Frequency <br /> Structure <br /> El <br /> Operation ater`We <br /> ❑ ❑L7- <br /> Well Construction <br /> 2. s Connection <br /> Structure Operation FlOdrA <br /> s Properly Graded to Sewer <br /> El4. Drain <br /> ❑ <br /> M❑ ❑ 5. Smooth/Cleanable y y <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation M_NT` <br /> ❑ ❑ . Smooth/Cleanabie <br /> ❑ 19. Cleaning Frequency <br /> Structure Operation IrdieS <br /> ❑ ❑ 0. Condition <br /> 11 itation 6 "r <br /> StructureROperatio <br /> Fo6d--" <br /> ❑ Storage <br /> El - 13. inse <br /> Structure nimal Dis O 1 <br /> ❑ va from Premises <br /> ❑ 15. Other <br /> Structure Operati -sewage Dispos <br /> ❑ ❑ Septic System <br /> ❑ ❑ 17. Se <br /> Structure Opera' Rabies Ya n RECEIVED BY INSPE T <br /> ❑ ❑ 8. Certificate on Premises <br /> VECTOR CONTROL I P N FORM <br /> EHD 40-06 4/6/12 Page 1 Of <br />