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r <br /> I <br /> A�uin SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ur X <br /> Y. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR ® CONTROL /"s ®pp <br /> VECTOR INSPECTION FORM <br /> DBA INSPEC ION DYE <br /> Structure Operation 77 `�/, <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> Y6 � <br /> 1:10 2. Cross-Connection .3 /6 y <br /> Structure Operation Manure Mana em t OWNER/ PERATOR P ONE <br /> ❑ ❑ 3. Spreading and Di/king /^f° 4) *6's- <br /> ❑ ❑ 4. Concrete Tank INSP CTION YPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning PR-,o <br /> ❑ ❑ 6. Compostin The items below represent code violations and must be corrected: <br /> Structure Operation Bird Dispo al <br /> ❑ ❑ 7. Burying4ith 2"of Cover > W-rlt_ <br /> ❑ ❑ 8. A r ed Concrete Tank <br /> ❑ ❑ 9. Re oval from Premises d <br /> Structure Operation Vecj6r Control <br /> ❑ ❑ 10 Domestic FI <br /> It. Fannia FI r <br /> ❑ ❑ 2. Larvae <br /> ❑ ❑ 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ EX 16. Moderate Population <br /> ❑ n 17. Heavy Population <br /> Structure ration FeedingMater <br /> ❑ ❑ 18. Water Troughs , <br /> ❑ ❑ 19. Cu s or Bowls <br /> 20. Food Stora2e <br /> Struc re Operation Houses <br /> ❑ 1 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin Fre uenc <br /> Structure Operation ateEN-Alp <br /> ❑ ❑ 1. Weil Construction <br /> 2. Cross Connection <br /> Structure Operation r P <br /> 11 ElPro ed Graded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covingr �C' <br /> 7. Cleaninq Fre uenc <br /> Structure Operation a �Q� <br /> ❑ ❑ Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cag <br /> ❑ ❑ . Condition sa t� j <br /> El El 11 itation <br /> Structure Operation o <br /> ❑ ❑ . Stora e <br /> El El KY' 13. Insect/Vermin <br /> Structure Operation animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation age Dis"o <br /> ❑ ❑ <br /> ...... Septic <br /> S stem <br /> ❑ ❑ 17. S <br /> Structure operation abies Vaccinatio RE D BY INSPE TOR <br /> ❑ ❑ 18. ert icate on Premises " <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 <br /> Page of <br />